Guns N’ Rosses

I’m a child of the ‘80s (hence the GNR reference) – and a partial product of the fraternity system.  There’s a tradition of ‘Hell Week’ in the Greek system.  It’s a rite of passage where pledges (potential members) are put through a series of difficult and harrowing activities that at the end result in their acceptance into the fraternity.  Fortunately, Sigma Nu did not see fit to follow this particular tradition, but I felt like I was living in a delayed version of this over the last few weeks…

Editor’s Note – Guns N’ Roses (GNR) was a popular rock band from the late ‘80s/early ‘90s and each titled section below represents one of their more popular songs.

Sweet Child O’ Mine

3 weeks ago the week started with a bad phone call.  It was early on Monday when a patient arrived in transfer from a hospital far away.  She had been transferred to another hospital but she was redirected to ours with a big problem.  She was 36 weeks pregnant and had started to bleed from a condition called placenta previa where the placenta is covering the cervix.  It’s a medical emergency and by the time she reached our labor and delivery unit her baby had already died within her womb.  And within minutes of her arrival her heart stopped as well.  She had just lost too much blood.  We did everything in our power to revive her – all while her family watched and prayed for a miracle. But that was not a miracle that would happen that day. As we finally stopped and prayed for her soul and for her family, I quietly cried. Knowing that this was the third maternal death of the month; but not knowing that yet another would happen by the end of the week.

Even as we were reeling from this terrible news we were unaware that the floodgates of labor were about to open up upon us.  The local government hospital had shut its doors to new admissions and EVERYBODY started coming to us.  Our hospital does around 80 deliveries per month and we’re adequately staffed and equipped for that type of volume.  But with the closure of the major hospital in Soddo, our volume immediately shot-up 500%.  For the next 5 days I experienced the most sustained medical chaos that I’ve ever experienced in the 26 years that I’ve been in medicine.  They just kept coming, and coming, and coming…  At one point we had 3 women pushing in the same room, at the same time, with delivery tables placed side-by-side.  We ran out of rooms.  We ran out of equipment.  We ran out of staff.  We ended up delivering 65 babies and performing 22 cesarean sections during those 5 days.

And during that time we experienced pretty much every type of high-risk pregnancy and complication that you can imagine.  If you took one of our major obstetric textbooks you would literally have read the entire book to cover all that we saw.  It was like an entire 4-year obstetric residency packed into 120 hours.  I’m still not sure whether to be amazed by that or frightened. We had one more maternal death before the week was done – that time it was from eclampsia and the result of hours and hours of seizures before she came to us. The pediatric side had 5 neonatal deaths. Despite a week with a lot of death, the overwhelming majority of our patients did well and we celebrated the life and sweet children that were born.

The one thing that brought a smile to my face during that time, though, was my medical staff.  Our pediatric team was superb. Our nurses and midwives worked tirelessly.  They came in to work on their vacation.  They worked extra shifts.  And they never, not once, complained about any of it.  They just did exactly what they needed to do and did it with excellence.  

Paradise City/Welcome to the Jungle

There’s a current virus traveling our planet but I’m not sure if you’ve heard of it?   Despite what the American President says, it is called “corona” or “COVID-19”.  It arrived in Ethiopia in mid-March and we’ve been preparing and watching for it here at Soddo Christian Hospital, but we hadn’t had any cases.  That was until RIGHT AFTER the obstetrical deluge had abated.  Then it arrived.  We had cases in our medical staff and most likely some of our patients as well.  I had been exposed and was tested but fortunately have been negative to this point. It’s been a game-changer in our hospital where we have cancelled our elective surgical cases and many additional precautions have been taken.

Live and Let Die

After the crazy week of deliveries and then the arrival of corona, we felt like we needed a break.  So we went for a very relaxing weekend to a town 2 hours away that sits by a beautiful lake and has amazing birds and monkeys.  So that’s what we did, along with the remaining expat family, the Loves.  It was a great weekend filled with the beauty of God’s creation, and a not-so-small amount of ice cream ingestion.

We came back last Sunday refreshed and ready (so we thought) to face the coming week.  Within an hour of returning to Soddo we started to hear gunshots.  We occasional hear gunshots from the prison across the street, but these were coming from another direction.  Where they weren’t supposed to be coming from.  And they continued… and continued.  We all have a “safe place”, which for us is our storage closet, an internal room that doesn’t have windows.  We prayed for God’s protection and we watched online as our church back in America prayed for us as well.

Then we got an alert that we had never received before.  A ‘mass casualty’ alert from our hospital ER.  We were having multiple gunshot victims brought in and they needed all the help that they could get.  I’m just a gynecologist, and I have exactly no training in surgical trauma, but with only one other expat surgeon on the campus I figured I would go and try to help in whatever way that I could.  I met Tim, the actual general surgeon, outside our houses and as we heard more gunshots he said “well, I guess we better run…”  So… we ran to the ER – not knowing what we would see as we walked in.

There were 4 victims when we arrived.  Some were calm, and some were not.  We started to assess those that were there and as we were finishing our initial evaluations the doors of the ER opened with more arriving.  They were not arriving by ambulance, they were arriving by “people” – friends were carrying victims in their arms for us to see.  All of the beds quickly filled with young people shot by AK-47s.  We moved some that were stable to the ICU, and the most critical were moved to the operating room.  I scrubbed and helped Tim with the most badly injured victim.  A bullet had gone through his chest, behind his heart, through his diaphragm, then through his stomach and finally his spleen which basically had exploded in his abdomen. Despite all that was done, this young man and child of God died before making it to the recovery area.

These were all things and scenes that I had never seen.  And I never want to see them again.  I mainly deal with with the beginning of life and before moving to Ethiopia rarely had to deal with death. It’s still hard for me to see death – especially death that seems preventable or unnecessary – and in many ways it’s haunting. I have a great and new respect for all those health workers that deal with trauma.  It’s physically, mentally, and emotionally draining.  All that I had seen on TV and movies about this kind of thing… cannot capture what it’s like. Over the course of a couple of days dozens of people were shot and an unknown of people were killed. It’s crazy to me that we’ll never know exactly how many people died.

Because of these events and some political turbulence in our area, we all decided to evacuate and left for safer areas on Tuesday.  We even had our own police escort during part of the journey.  We’re currently safe in the capital.

Things are returning to normal in Soddo and we’re looking at returning early this week.  Despite the challenges and struggles that we’ve recently had we can’t wait to return to our friends and to rejoin the work that God has for us.

I kind of wish Sigma Nu would have just gotten the whole ‘hell week’ thing over with in college and not deal with this now.  But I know that this is all part of His plan and I have a peace in that and in all that He is doing.

It’s not about me…

Since moving to Ethiopia almost 2 years ago, I’ve experienced many things for the first time. I have tried some food and drinks I didn’t know existed (some I enjoyed, some made me almost vomit), visited centuries-old churches, hiked mountains, learned a new language (sort of), lived in a culture that works almost completely on cash, had a garden, seen widespread poverty and horrific suffering, taught English, experienced a completely different calendar, rode a mule, and much more.

And, for the first time in my life, I’ve experienced words and deeds directed at me – both good and bad- on the basis of the color of my skin. I was not fully prepared for this experience, but I’m not sure I could have been.  On a daily basis, and sometimes dozens of times per day, people see me and yell at me. Many of these experiences are neutral in my mind. Adults and children alike yell, “forenji” or “China” (all foreigners are called Chinese here). I’m not sure what the point of this is, other than to remind me, “You’re not from around these parts,” which I am most certainly already aware of. It doesn’t hurt me when people say these things; they are true. Well, except I’m not Chinese. 

More recently people have been yelling “Corona,” which alerts me to the fact that people think because I’m white, I probably have the virus. Other times people yell, “Money, money, money” – based on the assumption that because I’m white, I’ve got some money that I might want to give to them. 

When I’m running, people yell other things.  Many of these are positive and encouraging, since I usually see the same people out each morning (Soddo has a LOT of exercisers!). “Nice!” “Good sport” “I appreciate you” “Stay strong” are comments from my morning acquaintances that bring a smile to my face. From strangers, the yelling is more questionable. Since I’m deaf in one ear and don’t have a good command of the language yet, I often don’t understand what’s being yelled. I think this may be for the best.

At times, good things have come my way here as a result of my skin tone. I’ve been introduced to important people, been moved to the front of lines, and been invited into the VIP section of events. People want to take selfies with me like I’m Angelina Jolie. Just because I’m white. (Note: I usually try to say “no” to special privileges, but then I’m reminded this is a culture of hospitality and this is a way to show honor to guests. Other times I say nothing and go along with the move to the front of a line.)

I’ve also experienced some more sinister things as a result of my color (presumably). I’ve had my purse stolen off my body and drug to the ground, been sexually harassed, had things thrown at me, and been swerved at by motorcycles, bajajes, buses, and even large Mack trucks. Lots of times.

I’m very aware that everywhere I go, I’m being stared at and observed because I’m a white woman.  Children sometimes are very afraid of me. My usual approach in most situations is to smile, wave, be friendly, make jokes. To do my best to speak with what little language skills I have (which usually makes people laugh). In short, I want to help people not be afraid of someone they don’t know or understand, so I make the first move toward relationship.

But every now and then, I get tired. Well, truth be told, it’s more than every now and then. It’s kind of exhausting knowing there’s an objectification going on, an assigning of characteristics or motives. It’s not that fun to be the object of fear, scorn, or demand. It can be nice to have some privileges thrown my way, but even that leaves me knowing something isn’t right.

Sometimes, I get pushed past the point of being nice and friendly. Instead of waving, I want to yell, throw something, punch someone. I don’t feel like leaving the safety of my house. I was warned that might happen in our pre-field training, which helps me recognize when those feelings are creeping up on me and find ways to manage the emotions and the weariness. Most of the time I can control myself, but sometimes….well….you know…

In spite of everything I’ve written so far, this post is really NOT about me. I’m not looking for sympathy here. After all, I made this choice (with some pretty strong promptings from God). I am free to leave if I want to. Overall, I really love living here and God gives me the grace on a daily basis to keep going.

What I am trying to say is that all this has helped me understand in a personal way that it STINKS being an object, not being understood, and being treated differently based on the color of your skin. It’s a bad feeling to be feared because of what you look like. It’s terrible to know that someone might harm you just because of how much melatonin is in your body.  

Historian Robin D.G. Kelly wrote that racism “…is not about how you look- it is about how people assign meaning to how you look.” Racism is terrible; I despise it. Racism is not the plan of a holy God who promises in Rev. 7 that there will be, “…a great multitude that no one could count, from every nation, tribe, people and language, standing before the throne and before the Lamb.” 

I can appreciate in a way I never could before why African Americans are tired, angry, want to throw things, feel misunderstood and targeted, and need a way to express themselves. It’s incredibly difficult when you know people are making comments, assumptions, and judgments toward you. I can understand not knowing what to do with all of it. I’ve only been at this a couple dozen months; I can’t imagine a lifetime of these feelings. I want to apologize to my black friends, students, and co-workers for not truly appreciating your plight before now. I wish I had done more listening. More acting.

So, mark my words: I will be part of solutions, not a perpetrator of injustices. I vow to do my best to love others simply because EVERY person is worthy of love. I will ask God to help me when it’s hard or when those individuals are judging me. Even when they’re yelling “Corona.” I will pray for America, indeed the whole world, to move toward equality. Soon.

Lord, help us all.

What are the odds???

If you played the odds, this woman should really be dead.  And so should her twins.  All of them.  That’s the reality of the numbers as it stands both here in Ethiopia, as well as any country in the world.  So whether she was at Brigham & Women’s Hospital in Boston, Brookwood Medical Center in Birmingham, or a rural clinic in Ethiopia, she faced overwhelming odds for both herself and her twins.  But God had other plans…

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Birhanesh was a healthy 20 year-old woman living in a rural area about 2 hours from Soddo.  She was pregnant with twins and her pregnancy had gone smoothly.  She presented to her local hospital in labor and they planned a cesarean section because of the position of the babies.  She was taken to the operating room where a spinal anesthetic was inserted and soon afterwards, she stopped breathing.  Just suddenly and tragically she stopped breathing.  They immediately inserted a tube to help her breath and performed an emergency cesarean section.

They initially thought that her breathing problems were due to the spinal anesthetic.  That it had gone “high/up” rather than “down” (this is a possible complication of spinals).  When the anesthetic should have worn off, they took the tube out but she still couldn’t breath and they had to immediately reinsert it.  Not knowing what was going on she was transferred to our hospital since we have ventilators and most hospitals in Ethiopia do not.

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When she arrived she was quickly transferred to the ICU but not before she was noted to have a seizure which, as you can imagine, is NOT a good sign.  When I arrived to examine her I also noticed that her urine catheter bag was full of blood. And then there was  blood in her breathing tube.  Again… NOT a good sign.  I was suspicious that she had a condition called DIC where basically your entire bodily system for safely stopping bleeding goes haywire and you can literally bleed to death internally in a matter of hours.  This combination of symptoms most closely fits a very rare condition called amniotic fluid embolism.

Amniotic fluid embolism is exceedingly rare (approximately 1/25,000 pregnancies) and exceptionally fatal (as high as 90%).  Those who DO survive have a 85% chance of suffering a significant neurologic injury.  Over half of the babies die, and of those that survive less than half of those escape neurologic injury.  So the odds on every level were against her, and her babies.  But God had other plans…

 

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I’ve seen this condition three times, and it’s one of the most frightening things to witness as an obstetrician.  The patient just suddenly stops breathing and then things get progressively worse, as if that’s possible.  There’s no magic treatment for this condition.  Mostly supportive care, waiting, and prayer.  Mostly prayer.

The first 36 hours didn’t see much improvement and I was not optimistic but then she suddenly started turning the corner and we were able to remove her breathing tube!  Later that day we were able to transfer her out of the ICU back to the ward where she would be able to meet her babies for the first time.

We were all very excited, but when we saw her the next morning we realized that a new problem had been revealed.  She had NO memory of her babies, of being pregnant, or of anyone in her family except for her mother.  This was a major disappointment for all of us.  She seemed to have come so far and yet her memory was gone.  We continued to pray and miraculously within a matter of days her memory had returned!  She was able to bond with her babies.  To feed them.  To truly reunite with her family.  We are supposed to limit the number of family members visiting because of corona virus but in her case, we were fine with a few extra people!

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One week to the day after her arrival she was able to walk out of our hospital with her healthy babies and her health restored.  What are the odds of this happening?!?!  Well, I’m glad you asked.  I reached back into my mathematics memory and calculated the odds:

Odds that she would survive and be healthy – 1 in 75

Odds that she AND 1 baby would be healthy and survive –  1 in 270

Odds that she AND BOTH babies would survive and be healthy – 1 in over 10,000

The odds were incredibly against her, but with God all things are possible!  In this strange time of the pandemic it’s good to be reminded that ultimately God really is in control and truly all things are possible!  No matter what the odds look like.

 

p.s. For those who like to geek-out on probabilities I calculated that the odds that she would get pregnant with twins, have an amniotic fluid embolism and then survive as they did:

1 in 700 million

But God had other plans…

 

(photos and story used with permission)

 

 

 

 

 

Our patient didn’t make it… so we ate him

Fair warning… this blog may contain information that is upsetting to those members of PETA and others who have a special heart for animals… You have been warned.

Much of what I do here at Soddo Christian Hospital has to do with training.  I’m so fortunate to be part of an international program called PAACS – which stands for the Pan African Academy of Christian Surgeons.  It was started back in the late 90’s with the vision of training African physicians to become general surgeons who would then stay within the continent and make a difference in their communities.  So far this program has been hugely successful and has graduated nearly 100 surgeons that practice throughout Africa.  Soddo hosts one of these programs and we currently have 5 residents training to be general surgeons and 3 to be orthopedic surgeons.

Screen Shot 2020-03-14 at 7.39.49 PMAs a surgeon in Ethiopia you are expected to be able to do some OB/GYN type surgeries which is where I come in.  General surgeons are truly “general” surgeons and must know who to do cesarean sections, hysterectomies, take care of ectopic pregnancies, as well as other gynecologic conditions.  They spend 3 months with me during their intern year and then continue to learn how to do cesarean sections throughout their 5 year program.

Today we had a surgical skills training program.  It was as basic as “how to tie surgical knots” and progressed to how to perform bowel and vascular surgeries.  As part of that program… we needed a goat.  I know… I know…  I realize that it’s troubling for some of my friends that animals are used in medical training.  And I’m not trying to debate that issue.  But I will say that using real tissues in order to train our surgeons provides an invaluable experience.

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So Thursday we bought a goat.  He cost about $125.  We named him “Tibs” – which is the name of the meat dish here that is grilled in a big pan.  We all felt a bit sorry for him, knowing his ultimate fate.  But he had a great attitude and seemed to accept his future.  Saturday morning was the lab and he was butchered by the local expert who knows how to do these things.  All I can say is that it was quick and as humane as possible.

 

 

Then we were able to perform our training session utilizing intestines, blood vessels, and extremities.  Our residents were able to practice actual major surgeries safely in our library.  In this way when they have an actual human patient on the OR table, they will be better prepared and trained to actually save a person’s life!

Nothing goes to waste here.  We try to appropriately use whatever it is to the best of our abilities and not throw away things that can be used.  Whether it’s zip-lock baggies, bottles, or old clothing.  So what do a bunch of surgical residents and faculty do after this lab?  Well… we ate him.  And for those who have not tried goat… it’s amazing!  It was actually my third time having goat this week and it was by far the best.  We enjoyed a great meal together and with our families.

 

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So as we bid farewell to “Tibs” we were thankful for him.  For his sacrifice.  He literally helped to train a group of surgical residents to better do their jobs.  And he provided an amazing meal that everyone was able to enjoy.  Thank you “Tibs”!

Please continue to pray for each of our residents as they continue their education here.  They have an ENORMOUS amount of information and skills to learn during their 5 years here.  But by God’s grace and hard work each one will be successful in their own way and will be a light to the medical community here and throughout Africa.

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.