I cannot say that my heart has healed yet from what we experienced in Ethiopia. Maybe it is not supposed to. I got tears in my eyes as we sang in church Easter Sunday the words of Chris Tomlin, especially the part about no more sorrow or pain.
There's a peace I've come to know
Though my heart and flesh may fail
There's an anchor for my soul
I can say "It is well"
Jesus has overcome
and the grave is overwhelmed...
And I will rise when He calls my name
No more sorrow, no more pain
I will rise on eagles' wings
Before my God fall on my knees
And rise
I will rise
We had dinner with a couple here in San Antonio that have a ministry called "For Hearts and Souls" where they do pediatric heart surgery all over the world, including Iraq, Kosovo, Mongolia, etc. They were a huge encouragement to us as they identified with our experiences.
One statement she wrote in her blog about their recent trip to Iraq struck me as true.
It is a difficult thing to have your heart broken by the things that break the heart of God.
Her husband, a pediatric heart surgeon, reiterated that sentiment at dinner, "That sounds romantic and all, but in reality your heart is BROKEN and that is not necessarily an easy thing." So, now when I hear songs or see images that make me cry a lot more easily, perhaps I am just allowing myself to feel that broken heart. Why does it take an act of God like an earthquake in Haiti for people to wake up to the realities of lack of medical care in developing countries? When will it become unacceptable for us to stand by with all of our excess in the US without giving and going to those in need? I can either ignore or forget what I've seen or I can do something about it and inspire others to do the same.
Monday, April 5, 2010
Wednesday, March 10, 2010
Scavenger Hunts, The Trip that Never Ends, and The Million Dollar Question
Scavenger Hunts in Addis
Our flight from Bahir Dar to Addis on Wednesday night was uneventful other than being delayed over an hour (pretty much uneventful as all the flights seem to be delayed regularly!). We took a taxi to the SIM Guesthouse which we had stayed at during our previous trip to Addis for our visas. I had emailed to reserve rooms, but apparently their internet was down so they did not receive my message. We took keys for spare rooms when we arrived after midnight and let ourselves into open rooms. Ryan and I got twin beds in our room as that was the only one available. This ended up working out because Ryan had coughing fits each night which caused him to cough repeatedly, so hard that I thought he may throw up at times. Austin stated that he was going to take as many showers as he could, and he proved that by taking one each morning and night. I had to admit that it was quite a treat to have a hot shower after nearly 6 weeks of bucket baths. We met up with some long-term missionaries which Ryan had contacted via email before we arrived. They graciously and generously drove us around both days we were there so that we could do some shopping.
Our scavenger hunts began. We were looking for a handmade area rug, but all we could find at souvenir shops were the small ones. We had admired the huge carpets in the churches at Lalibela and were eager to have this lovely reminder of Ethiopia adorning our house in the US. It proved harder than we thought. Our previous excursion to Addis had resulted in us coming back empty-handed, but we were determined. The missionaries drove us to a rug shop where they employed between 75 and 100 women to make rugs by hand. Some sorted the wool into colors. Next, they combed the wool repeatedly to make it soft. Then the wool was spun into long threads. In the final room, there were a myriad of looms with women rapidly weaving or tying knots and cutting them with razor blades to the correct length. It was amazing! We bought one of our rugs there, but Austin and Melissa wanted one similar to it, so our hunt was not finished. We had lunch at an orphanage which taught vocational skills, one of which was to be restaurant cooks servers, etc.. They had coconut macaroons which apparently (since I detest coconut- its texture makes it inedible for me) were amazing! They were amazing enough that after the umpteenth store and finally finding a second rug late that evening, the second scavenger hunt became finding more of those coconut macaroons. We walked around the Piazza area on Friday looking for the macaroons in two teams: Austin and Melissa vs. Ryan and me. The typical conversation went like this:
“Do you have coconut macaroons?”
“Yes. Like spaghetti?”
“No no, not macaroni. MacaROONS, like a cookie? Coconut cookie? Coconut macaroon? Coco… nevermind.” NEXT!
We never did find any more coconut macaroons, and the orphanage was too far to travel to just for cookies. The scavenger hunt did entertain 4 adults for the bulk of an afternoon.
This is the Trip that Never Ends
It just goes on and on my friends. Some people started travelling on Ethiopian. And they continued travelling forever just because this is the trip that never ends, it just goes on and on and on. Some people tried to board the plane not knowing what it was, and they continued travelling forever just because of Ethiopia, engines, eagles, and El Nino… forever just because this is the trip that never ends…
We headed to the airport in Addis Ababa to begin our long series of flights home around 6pm. Since Ryan and I were leaving on expired visas (they expired one day before we left due to the mix up in counting 10 day extension from date of issue rather than previous visa’s date of expiration) and the potential problem with that. We held our breath as the guy at the ticket counter examined our passport. “Your visa is expired,” he said. We explained that we had been told it would be okay since it was only one day. He replied, “I hope so. I don’t care but you’ll probably have to pay $20 to leave when you get to the immigration counter.” That’s what we were afraid of. At least we made it past one person. Ryan and I looked at each other as we approached immigration. We just had to get on the other side of the glass windows and we would be home free. Literally. Going home free of a penalty. Going home at all! The man behind the glass window held the stamp next to the counter, looking down his nose at our visas. “Your visa has expired. You’ll need to…” Ryan interrupted him, “We went to the immigration office and talked to them about this situation. They told us it would be fine.” I added, “We have the name of the guy who told us that.” He looked up at us, stamp poised in his hand. Please, I thought, please just give us the stamp. (Come to think of it, it reminded me a lot of the movie “Terminal” where Tom Hanks is stuck in the airport because he cannot get a stamp on his passport.) The immigration officer looked at us, smirked, and he stamped the passports! Home free!! We stopped just beyond the glass and prayed in gratitude for the resolution of a difficult situation.
We knew our flight connection in DC would be tight, but both flights which went to San Antonio were relatively early Saturday morning, so we had no choice but to try to make them. As the time to board our plane came and went without so much as a hint of movement to start the process by the Ethiopian Airlines employees, we became antsy. No announcement was made. No one seemed to be in a hurry. Finally, when the time our plane was to actually leave had passed, mass chaos reigned as they finally started the boarding process. We sighed. Our connection time was slipping away, and there was no explanation for it. An hour later, we were on our way. We thought, well, there goes the earlier flight. Maybe we can catch the last flight to San Antonio.
After a 7 hour flight, we landed in Rome for refueling. No one was allowed to get off the plane. Just as we were hoping to take off again, they announced that there had been an engine failure and there would be a “short” delay while they fixed the engine. THREE hours later, hot and tired of the uncertainty, knowing that we would miss all of our connections in DC, we left Rome. 10 hours later, we landed in the United States and headed to the ticket counter at Southwest Airlines to see what could be salvaged of our flights. If we wanted to fly with no additional fees to upgrade our tickets, the only course of action was to get a hotel and try to fly stand-by the next day.
Getting stuck in the airport wasn’t all bad. We paid a very low rate for a nice room at the Sheraton, relishing the super-soft beds, the hot showers with consistent water pressure, and good friends to share it with. The beds were so tempting after all the travelling and trying to sleep upright, but how many times are you in Washington DC? We took a shuttle, bus, and a subway to the Mall area by the capital and took in the sites! Ethiopia struck Austin again who was having some GI issues. A guy directed him into “the building with the green roof.” Ryan and I waited on the Mall, taking pictures of sunset on the Capitol and Washington Monument. Austin came out a short time later, his eyes wide with excitement. “That’s not just any old building with a green roof. That’s the Smithsonian Museum of Natural History! And it’s free! Come check it out!” We took a quick tour, seeing life-sized replicas of a whale, a bunch of dinosaurs, an elephant, sea creatures, lions, polar bear, walrus, moose, etc. etc. I definitely could spend at least a day there looking at everything. Darkness fell on Washington DC while we were in the museum. We hurried to see as much as we could as we became colder throughout the night. I had brought clothes for Ethiopia, not for the coolness of America in winter. We saw the Capitol and the Supreme Court Building. Ryan commented that day, “I will not look at the American flag the same way again.” In Ethiopia, our presence in the country was noted, we knew our emails may be monitored, and we knew that if we said anything specifically negative about the government, considering the nearness of the upcoming elections in May, they could and would rapidly kick us out of the country. Blogging was blocked completely (which is why I sent emails to family to upload. Thanks guys!) We marveled as we stood on the Capitol steps that we could say anything about our government right on its front steps. We might even get press coverage! Freedom of Speech is huge!
We walked and walked that night. We saw the Washington Monument (which looks much bigger up close!), the White House, and we were walking to the Lincoln Memorial when Ethiopia struck Austin yet again. It was very dark, and we had not seen a bathroom since several hours earlier at the Museum. Nothing was likely to be open at this hour. Ryan and I guarded the path near the lake, and Austin, grateful for darkness, a clump of trees, and loud ducks in the small pond next to us, dropped the kids off. He made our previously agreed upon verbal signal that he was finished, and we nonchalantly continued on our way. I’m not exaggerating when I say that only 100 yards away we found the public restrooms. “Don’t tell that I just risked being put in prison for defecating in public on government property, on the Mall no less, when the bathroom is right here!! Aww man!” Good times. We quickly saw the Lincoln Memorial and the WWII Memorial before making the 1.5 hour trek via public transport home. That bed felt sooo good!
Sunday was another comedy of errors. We flew stand-by, and the first plane looked very full. Although we were first on the list for stand-by, we couldn’t insist on going in front of a couple with a newly-adopted Ethiopian 1 yr old child. We knew what they had been through the previous day with us on that same flight, and as first time parents, I’m sure they were a bit traumatized by the experience of trying to calm a screaming baby for 20 hours. We deferred to them. Finally, we made it on the last flight of the day which would get us home. It was a full flight as well, but we made it on and it was only a half hour delayed! We had just sat down when the captain came on the loudspeaker. “We were doing our routine inspections and found that we hit a bird on the left wing on our previous flight. It will take an hour to get someone to come look at it. We apologize.” A few minutes later, they instructed us to deplane because we would be getting on a different airplane. Apparently either the light had broken or there was a hole in the wing. I like to tell the extreme story because it seems more entertaining, but it was probably just a broken beacon light. In my fatigue, I found it almost amusing how upset people were about an hour delay. I was thinking, “You have no idea!” We boarded the second plane and finally made it to Chicago. We raced to get on the stand-by list in Chicago, practically running the full length of the airport just to find out that we had miss-read the flight board and our gate was actually RIGHT NEXT TO the gate we had gotten off at. Ahh. Such is a jet-lagged mind. We ran back to the gate and found out we had made the flight. It was delayed. Why not?? First it was delayed 10 minutes, then 25, then 40, then 50 minutes. I had ceased caring. Delay me all you want, just get me to San Antonio tonight!
They did. We arrived in San Antonio at 11pm. Ryan had missed his flight to go speak at a conference for biomechanics in New Orleans. I was so sad for him. His boss at work filled in for him, which was no problem, but I hurt for Ryan that he did not get the opportunity to present his work. I started class at 9am Monday morning and Ryan returned to work on Tuesday. It is only one week from today when we will find out on Match Day where we will be going for the next 4 years of our life. Thursday, March 18, between 11am and noon, I will open up an envelope which has the name of the residency program. This is an exciting time in our lives and for my medical school class, this one is for all the marbles, for everything we’ve worked for.
The Million Dollar Question
And the million dollar question: What do we think now of our potential to work in Africa in the future?? We discussed how to answer this at length. I believe Ryan still leans slightly towards pursuing his career here in America where things are efficient and he feels most effective, but we both agreed that we now know what it could potentially feel like to live and work overseas. We know the good and the bad, the tremendous needs, the masses of issues and basic problems which he would be very good at addressing. I think it would be better if you spoke to him in person as he is not nearly as keen on writing as I am. Speaking for myself, I am conflicted about my desire to work in Ethiopia in particular. Dr. Browning talked to me about Fistula work and where he sees the future of it. He said, “We are training a lot of surgeons in fistula repair here in Ethiopia. Outside of Ethiopia, there are only 4 full-time fistula surgeons in the whole of Africa.” We talked about raising a family overseas, about working in an area with good support, good schools for children, good opportunities for both spouses, etc. Dr. Browning suggested I check out MercyShips which is a well-established, well-run floating hospital that docks at various western African nations which are, for the most part, war-torn and extremely needy. “They are always looking for fistula surgeons.” Dr. Browning himself had volunteered for MercyShips at one time in his career and spoke highly of the school for children on the ship and suggested that Ryan would likely have an easy time finding something meaningful to do. Dr. Browning’s last words to me were, “Finish your training, come back and I’ll train you up in fistulas and you can go anywhere.”
We also realize that the career and world landscape may look radically different in 4 years. There may be other areas after my training which would utilize both of our specific skill sets, such as Sierra Leone. Sierra Leone has a major prosthetics project as well as a fistula center. But for now, we will cherish the conversation we had with Dr. Alan, an older, wiser surgeon from Ireland who regularly travels to Ghana. He spoke to us while we were on a boat on the lake one weekend. “You can plan your life, but it rarely goes that way. The main objective should be to glorify God in whatever you do. If you read the Bible, God’s word, and are praying daily, you just can’t go wrong. You aren’t somehow going to miss God’s will for your life if you do that. It’s good to have a general goal in mind, but don’t be surprised at the twists and turns you will take.”
Our flight from Bahir Dar to Addis on Wednesday night was uneventful other than being delayed over an hour (pretty much uneventful as all the flights seem to be delayed regularly!). We took a taxi to the SIM Guesthouse which we had stayed at during our previous trip to Addis for our visas. I had emailed to reserve rooms, but apparently their internet was down so they did not receive my message. We took keys for spare rooms when we arrived after midnight and let ourselves into open rooms. Ryan and I got twin beds in our room as that was the only one available. This ended up working out because Ryan had coughing fits each night which caused him to cough repeatedly, so hard that I thought he may throw up at times. Austin stated that he was going to take as many showers as he could, and he proved that by taking one each morning and night. I had to admit that it was quite a treat to have a hot shower after nearly 6 weeks of bucket baths. We met up with some long-term missionaries which Ryan had contacted via email before we arrived. They graciously and generously drove us around both days we were there so that we could do some shopping.
Our scavenger hunts began. We were looking for a handmade area rug, but all we could find at souvenir shops were the small ones. We had admired the huge carpets in the churches at Lalibela and were eager to have this lovely reminder of Ethiopia adorning our house in the US. It proved harder than we thought. Our previous excursion to Addis had resulted in us coming back empty-handed, but we were determined. The missionaries drove us to a rug shop where they employed between 75 and 100 women to make rugs by hand. Some sorted the wool into colors. Next, they combed the wool repeatedly to make it soft. Then the wool was spun into long threads. In the final room, there were a myriad of looms with women rapidly weaving or tying knots and cutting them with razor blades to the correct length. It was amazing! We bought one of our rugs there, but Austin and Melissa wanted one similar to it, so our hunt was not finished. We had lunch at an orphanage which taught vocational skills, one of which was to be restaurant cooks servers, etc.. They had coconut macaroons which apparently (since I detest coconut- its texture makes it inedible for me) were amazing! They were amazing enough that after the umpteenth store and finally finding a second rug late that evening, the second scavenger hunt became finding more of those coconut macaroons. We walked around the Piazza area on Friday looking for the macaroons in two teams: Austin and Melissa vs. Ryan and me. The typical conversation went like this:
“Do you have coconut macaroons?”
“Yes. Like spaghetti?”
“No no, not macaroni. MacaROONS, like a cookie? Coconut cookie? Coconut macaroon? Coco… nevermind.” NEXT!
We never did find any more coconut macaroons, and the orphanage was too far to travel to just for cookies. The scavenger hunt did entertain 4 adults for the bulk of an afternoon.
This is the Trip that Never Ends
It just goes on and on my friends. Some people started travelling on Ethiopian. And they continued travelling forever just because this is the trip that never ends, it just goes on and on and on. Some people tried to board the plane not knowing what it was, and they continued travelling forever just because of Ethiopia, engines, eagles, and El Nino… forever just because this is the trip that never ends…
We headed to the airport in Addis Ababa to begin our long series of flights home around 6pm. Since Ryan and I were leaving on expired visas (they expired one day before we left due to the mix up in counting 10 day extension from date of issue rather than previous visa’s date of expiration) and the potential problem with that. We held our breath as the guy at the ticket counter examined our passport. “Your visa is expired,” he said. We explained that we had been told it would be okay since it was only one day. He replied, “I hope so. I don’t care but you’ll probably have to pay $20 to leave when you get to the immigration counter.” That’s what we were afraid of. At least we made it past one person. Ryan and I looked at each other as we approached immigration. We just had to get on the other side of the glass windows and we would be home free. Literally. Going home free of a penalty. Going home at all! The man behind the glass window held the stamp next to the counter, looking down his nose at our visas. “Your visa has expired. You’ll need to…” Ryan interrupted him, “We went to the immigration office and talked to them about this situation. They told us it would be fine.” I added, “We have the name of the guy who told us that.” He looked up at us, stamp poised in his hand. Please, I thought, please just give us the stamp. (Come to think of it, it reminded me a lot of the movie “Terminal” where Tom Hanks is stuck in the airport because he cannot get a stamp on his passport.) The immigration officer looked at us, smirked, and he stamped the passports! Home free!! We stopped just beyond the glass and prayed in gratitude for the resolution of a difficult situation.
We knew our flight connection in DC would be tight, but both flights which went to San Antonio were relatively early Saturday morning, so we had no choice but to try to make them. As the time to board our plane came and went without so much as a hint of movement to start the process by the Ethiopian Airlines employees, we became antsy. No announcement was made. No one seemed to be in a hurry. Finally, when the time our plane was to actually leave had passed, mass chaos reigned as they finally started the boarding process. We sighed. Our connection time was slipping away, and there was no explanation for it. An hour later, we were on our way. We thought, well, there goes the earlier flight. Maybe we can catch the last flight to San Antonio.
After a 7 hour flight, we landed in Rome for refueling. No one was allowed to get off the plane. Just as we were hoping to take off again, they announced that there had been an engine failure and there would be a “short” delay while they fixed the engine. THREE hours later, hot and tired of the uncertainty, knowing that we would miss all of our connections in DC, we left Rome. 10 hours later, we landed in the United States and headed to the ticket counter at Southwest Airlines to see what could be salvaged of our flights. If we wanted to fly with no additional fees to upgrade our tickets, the only course of action was to get a hotel and try to fly stand-by the next day.
Getting stuck in the airport wasn’t all bad. We paid a very low rate for a nice room at the Sheraton, relishing the super-soft beds, the hot showers with consistent water pressure, and good friends to share it with. The beds were so tempting after all the travelling and trying to sleep upright, but how many times are you in Washington DC? We took a shuttle, bus, and a subway to the Mall area by the capital and took in the sites! Ethiopia struck Austin again who was having some GI issues. A guy directed him into “the building with the green roof.” Ryan and I waited on the Mall, taking pictures of sunset on the Capitol and Washington Monument. Austin came out a short time later, his eyes wide with excitement. “That’s not just any old building with a green roof. That’s the Smithsonian Museum of Natural History! And it’s free! Come check it out!” We took a quick tour, seeing life-sized replicas of a whale, a bunch of dinosaurs, an elephant, sea creatures, lions, polar bear, walrus, moose, etc. etc. I definitely could spend at least a day there looking at everything. Darkness fell on Washington DC while we were in the museum. We hurried to see as much as we could as we became colder throughout the night. I had brought clothes for Ethiopia, not for the coolness of America in winter. We saw the Capitol and the Supreme Court Building. Ryan commented that day, “I will not look at the American flag the same way again.” In Ethiopia, our presence in the country was noted, we knew our emails may be monitored, and we knew that if we said anything specifically negative about the government, considering the nearness of the upcoming elections in May, they could and would rapidly kick us out of the country. Blogging was blocked completely (which is why I sent emails to family to upload. Thanks guys!) We marveled as we stood on the Capitol steps that we could say anything about our government right on its front steps. We might even get press coverage! Freedom of Speech is huge!
We walked and walked that night. We saw the Washington Monument (which looks much bigger up close!), the White House, and we were walking to the Lincoln Memorial when Ethiopia struck Austin yet again. It was very dark, and we had not seen a bathroom since several hours earlier at the Museum. Nothing was likely to be open at this hour. Ryan and I guarded the path near the lake, and Austin, grateful for darkness, a clump of trees, and loud ducks in the small pond next to us, dropped the kids off. He made our previously agreed upon verbal signal that he was finished, and we nonchalantly continued on our way. I’m not exaggerating when I say that only 100 yards away we found the public restrooms. “Don’t tell that I just risked being put in prison for defecating in public on government property, on the Mall no less, when the bathroom is right here!! Aww man!” Good times. We quickly saw the Lincoln Memorial and the WWII Memorial before making the 1.5 hour trek via public transport home. That bed felt sooo good!
Sunday was another comedy of errors. We flew stand-by, and the first plane looked very full. Although we were first on the list for stand-by, we couldn’t insist on going in front of a couple with a newly-adopted Ethiopian 1 yr old child. We knew what they had been through the previous day with us on that same flight, and as first time parents, I’m sure they were a bit traumatized by the experience of trying to calm a screaming baby for 20 hours. We deferred to them. Finally, we made it on the last flight of the day which would get us home. It was a full flight as well, but we made it on and it was only a half hour delayed! We had just sat down when the captain came on the loudspeaker. “We were doing our routine inspections and found that we hit a bird on the left wing on our previous flight. It will take an hour to get someone to come look at it. We apologize.” A few minutes later, they instructed us to deplane because we would be getting on a different airplane. Apparently either the light had broken or there was a hole in the wing. I like to tell the extreme story because it seems more entertaining, but it was probably just a broken beacon light. In my fatigue, I found it almost amusing how upset people were about an hour delay. I was thinking, “You have no idea!” We boarded the second plane and finally made it to Chicago. We raced to get on the stand-by list in Chicago, practically running the full length of the airport just to find out that we had miss-read the flight board and our gate was actually RIGHT NEXT TO the gate we had gotten off at. Ahh. Such is a jet-lagged mind. We ran back to the gate and found out we had made the flight. It was delayed. Why not?? First it was delayed 10 minutes, then 25, then 40, then 50 minutes. I had ceased caring. Delay me all you want, just get me to San Antonio tonight!
They did. We arrived in San Antonio at 11pm. Ryan had missed his flight to go speak at a conference for biomechanics in New Orleans. I was so sad for him. His boss at work filled in for him, which was no problem, but I hurt for Ryan that he did not get the opportunity to present his work. I started class at 9am Monday morning and Ryan returned to work on Tuesday. It is only one week from today when we will find out on Match Day where we will be going for the next 4 years of our life. Thursday, March 18, between 11am and noon, I will open up an envelope which has the name of the residency program. This is an exciting time in our lives and for my medical school class, this one is for all the marbles, for everything we’ve worked for.
The Million Dollar Question
And the million dollar question: What do we think now of our potential to work in Africa in the future?? We discussed how to answer this at length. I believe Ryan still leans slightly towards pursuing his career here in America where things are efficient and he feels most effective, but we both agreed that we now know what it could potentially feel like to live and work overseas. We know the good and the bad, the tremendous needs, the masses of issues and basic problems which he would be very good at addressing. I think it would be better if you spoke to him in person as he is not nearly as keen on writing as I am. Speaking for myself, I am conflicted about my desire to work in Ethiopia in particular. Dr. Browning talked to me about Fistula work and where he sees the future of it. He said, “We are training a lot of surgeons in fistula repair here in Ethiopia. Outside of Ethiopia, there are only 4 full-time fistula surgeons in the whole of Africa.” We talked about raising a family overseas, about working in an area with good support, good schools for children, good opportunities for both spouses, etc. Dr. Browning suggested I check out MercyShips which is a well-established, well-run floating hospital that docks at various western African nations which are, for the most part, war-torn and extremely needy. “They are always looking for fistula surgeons.” Dr. Browning himself had volunteered for MercyShips at one time in his career and spoke highly of the school for children on the ship and suggested that Ryan would likely have an easy time finding something meaningful to do. Dr. Browning’s last words to me were, “Finish your training, come back and I’ll train you up in fistulas and you can go anywhere.”
We also realize that the career and world landscape may look radically different in 4 years. There may be other areas after my training which would utilize both of our specific skill sets, such as Sierra Leone. Sierra Leone has a major prosthetics project as well as a fistula center. But for now, we will cherish the conversation we had with Dr. Alan, an older, wiser surgeon from Ireland who regularly travels to Ghana. He spoke to us while we were on a boat on the lake one weekend. “You can plan your life, but it rarely goes that way. The main objective should be to glorify God in whatever you do. If you read the Bible, God’s word, and are praying daily, you just can’t go wrong. You aren’t somehow going to miss God’s will for your life if you do that. It’s good to have a general goal in mind, but don’t be surprised at the twists and turns you will take.”
Thoughts from Shannon, What Works
I meant for the last blog to be the completion of my thoughts on Bahir Dar, but alas, I have come back to the computer to write a few more.
-While we were in a surgical case, I asked the doctors if they had been able to see the clowns while they were here. After each answered negatively, although regretfully, the nurse anesthetist piped up from his corner of the room. “We have our own circus here in the OR.” Ha! If you could see it, you would know just how true that statement feels!!!
-A German girl, Anita, came to the Fistula Hospital to do research on the social aspects of coming to be healed of the fistula, perceptions of the cause of fistula before and after treatment, effects of the education provided by the Fistula Hospital while they are being treated, etc. Anita had difficulty finding a translator, so I suggested she call Rekik, a girl who had been translating for the English classes which Ryan taught at KHChurch. I’m happy to say that it was a near perfect match! Rekik has a degree in sociology and needed a job with steady income to supplement her volunteer work at the church. Anita told me she was able to sit back and simply watch Rekik compassionately and effectively interview the patients. I was so glad to hear this as Rekik has been very dear to us during our time here. We would love to help her obtain her MPH (Masters in Public Health) in the future because she is intelligent, innovative, a committed Christian wanting to serve her country, and she comes from a very poor background and would be unable to pay for her continued education. She did not broadcast her desire for money, but she simply shared her dreams with us when asked. We are praying about this possibility. It is only about $3-5000 for her to get the degree. Many experts say the key to the development of a country in a peaceful way is the education of women. Bingo. Rekik may just be the perfect way to start.
-I had a long conversation with an OB/GYN who was training for a short time at the fistula hospital. Here are some numbers quoted to me:
80-90 million people. A few thousand doctors, about 500 specialists.
1 doctor for 46,000 people. 1 radiologist for 250,000 people.
General practitioners see 50-70 patients a day in the outpatient setting
Specialists see about 30 patients in addition to the ~40 inpatients they care for 24/7 plus their lecturing duties
Nurses care for up to 80-90 patients apiece!
He said the following:
“I just do what I can and leave the rest to God.”
“If I thought of the big picture, I would probably have to quit or leave Ethiopia at least.”
“If I save 1 mother from dying, I have to hold onto that- that I did something good. I know I cannot give good care to 40 patients at once.”
From this conversation, I have realized that people here have to rely on blocking things out, refusing to think of what they are not able to do and instead focusing on what they can do. This is the only way that they survive. Some say that different practices/behaviors may be deemed acceptable in that culture only if those cultural practices are working (i.e. people are not dying or suffering). In a strange way, this IS working to a certain degree, and until significant change comes to Ethiopia, this HAS to do. It is working in the sense that this doctor continues to serve his people and has not left the country. It is working in the sense that people have vastly different expectations regarding their optimism of getting out of the hospital alive and different expectations regarding how much they will be served at the hospital. Some may argue that it isn’t working because people are dying, but I think perhaps their method of delivering healthcare works because they are making a difference for some people, albeit smaller than one would aspire to.
-While we were in a surgical case, I asked the doctors if they had been able to see the clowns while they were here. After each answered negatively, although regretfully, the nurse anesthetist piped up from his corner of the room. “We have our own circus here in the OR.” Ha! If you could see it, you would know just how true that statement feels!!!
-A German girl, Anita, came to the Fistula Hospital to do research on the social aspects of coming to be healed of the fistula, perceptions of the cause of fistula before and after treatment, effects of the education provided by the Fistula Hospital while they are being treated, etc. Anita had difficulty finding a translator, so I suggested she call Rekik, a girl who had been translating for the English classes which Ryan taught at KHChurch. I’m happy to say that it was a near perfect match! Rekik has a degree in sociology and needed a job with steady income to supplement her volunteer work at the church. Anita told me she was able to sit back and simply watch Rekik compassionately and effectively interview the patients. I was so glad to hear this as Rekik has been very dear to us during our time here. We would love to help her obtain her MPH (Masters in Public Health) in the future because she is intelligent, innovative, a committed Christian wanting to serve her country, and she comes from a very poor background and would be unable to pay for her continued education. She did not broadcast her desire for money, but she simply shared her dreams with us when asked. We are praying about this possibility. It is only about $3-5000 for her to get the degree. Many experts say the key to the development of a country in a peaceful way is the education of women. Bingo. Rekik may just be the perfect way to start.
-I had a long conversation with an OB/GYN who was training for a short time at the fistula hospital. Here are some numbers quoted to me:
80-90 million people. A few thousand doctors, about 500 specialists.
1 doctor for 46,000 people. 1 radiologist for 250,000 people.
General practitioners see 50-70 patients a day in the outpatient setting
Specialists see about 30 patients in addition to the ~40 inpatients they care for 24/7 plus their lecturing duties
Nurses care for up to 80-90 patients apiece!
He said the following:
“I just do what I can and leave the rest to God.”
“If I thought of the big picture, I would probably have to quit or leave Ethiopia at least.”
“If I save 1 mother from dying, I have to hold onto that- that I did something good. I know I cannot give good care to 40 patients at once.”
From this conversation, I have realized that people here have to rely on blocking things out, refusing to think of what they are not able to do and instead focusing on what they can do. This is the only way that they survive. Some say that different practices/behaviors may be deemed acceptable in that culture only if those cultural practices are working (i.e. people are not dying or suffering). In a strange way, this IS working to a certain degree, and until significant change comes to Ethiopia, this HAS to do. It is working in the sense that this doctor continues to serve his people and has not left the country. It is working in the sense that people have vastly different expectations regarding their optimism of getting out of the hospital alive and different expectations regarding how much they will be served at the hospital. Some may argue that it isn’t working because people are dying, but I think perhaps their method of delivering healthcare works because they are making a difference for some people, albeit smaller than one would aspire to.
Last few days in Bahir
Tuesday we were monitoring laboring patients in the maternity ward when the midwives motioned for me to come examine a new arrival. Clearly, an umbilical cord was hanging out. Retained placenta? That was just the beginning. Her referral form stated, “blah blah health center referred to Any Hospital for retained twin.” She had delivered her first twin on Sunday, and now it was Tuesday! On exam, her amniotic sac was intact. I held my breath, and listened for a heartbeat. It was there- on day three after his brother or sister entered the world!! I wondered why she had waited so long to come to the hospital. “How far away does she live?” A midwife grabbed the chart, then said, “800 km.” A lightbulb came on. That’s why her referral form said, “To Any Hospital” and why she had taken so long to come.
Meanwhile, the laboring woman in the other room had prolonged 2nd stage (medicalese for: the part where the mom pushes the baby out). There were decelerations of the fetal heart rate (which can indicate fetal distress, head compression, or an umbilical cord wrapped around its neck, etc). Surely these patients warranted a phone call to the doctor! No, I was informed that they doctor would come around sometime after lunch, which was more than 3 hours away. Feeling helpless (we couldn’t give medications to speed up delivery without his signature), I watched over them carefully and then took my lunch.
When the doctor finally came, the first patient was given pitocin for augmentation of the delivery while we took the latter to c-section. This took an act of congress. (Actually, with the political process going the way it is, it was slightly less of a hassle.) We had to wait until the general surgeons were done with their current operations, wait for nurses to be available to get a stretcher, wait while the patient got onto the stretcher and was wheeled outside and through the other wards and into the OR. A live baby was born, although the baby was obviously distressed and took longer to breathe. Upon return to the ward, I checked on the woman with the retained twin. She had delivered! I peeled back the blanket to take a peek at the baby. I was startled to see the baby grunting, gasping for breath. I hurried to find the midwife. “What are we doing for that baby, the premature retained twin?” He looked at me, “Why? What’s wrong?” I answered, frustrated, “Did you examine him? He’s grunting, struggling to breathe!” He walked over and after looking at the baby, he stated, “We need to transfer him to the pediatric ward.” A little perturbed, I probed further, “Why wasn’t this done before?” He stopped in the hallway, but I motioned for him to continue, adding, “This is urgent! The baby cannot breathe!” He quickened his pace and explained, “There is no one in charge of the baby once it is delivered.” I was not satisfied. “But why was this not done immediately after delivery? Why did I find it just because I was curious to see her baby?” He repeated, “No one is assigned to the babies unless something is noticed at delivery. We are in charge of the mothers, and as you can see,” he motioned with his hand, “we have a lot of patients.”
In the end, no transfer was made because the mother had no one to support it financially and follow-up would have been necessary but impossible for this rural-dwelling woman who had travelled so far. I considered paying the $20 for the hospital stay of the baby, but I decided not to because after seeing the “Neonatal ICU” area which only had the capacity to put babies (unattended for the most part) wrapped and under light bulbs for heat with one oxygen tube and one NG tube (for feeding) and antibiotics. Even if they could have saved the little guy’s life, he would have been at risk of being in such a remote area as a premature infant. No, as hard as it is to stomach the statement, it was probably best to simply allow him to die peacefully next to his mother. And that’s what happened.
Comic relief
I had a few t-shirts which I rotated wearing with scrubs to go to work. As I was waiting for deliveries one day, the midwives were trying to remember my name. They said, “Is your name Dr. Sue-ez?” They got the S part correct, but I couldn’t understand how the rest of my name had been so mixed up. “You know, like the back of your shirt says,” one of them explained. Suddenly, I realized their confusion. My shirt had a quote on the back with the author’s name written underneath.
“A person is a person, no matter how small.” Signed, as you may have guessed it, Dr. Seuss.
I laughed so hard my sides hurt. “You think my name is Dr. Seuss? Haven’t you heard of the author who writes children’s books like ‘Green Eggs and Ham,’ ‘The Cat in the Hat,’ ‘Oh, the Places You’ll Go,’ and makes up silly drawings of animals/people?” Of course they hadn’t. But it made for a great laugh for me. I also thought to myself, What kind of person would wear a shirt with their own quote on it?
Lots of Tea!
It is a cultural formality to invite others to drink tea with you, so on my last day at the hospital and in Bahir Dar, we all drank many cups of tea and coffee. We had some in the morning with staff from the hospital, some at the Fistula Hospital, and in the afternoon I invited all of the students I had interacted with to come to a special tea to say goodbye to them. I was able to buy all 25 of them coffee, tea, or soda for about $7. Beautiful. We had a great time of reminiscing, they gave me a speech, and I was able to thank them for being my friends for the past 6 weeks, wishing them well in the rest of their careers. We took pictures and in general, it was a great way to wrap up my time in the hospital.
The leaders of the church invited Ryan and me to dinner with them. They presented us (especially Ryan) a certificate of thanks for his work in teaching at the Compassion program, coaching soccer, and donating soccer balls, clothing, and pens for their church. They also presented us with gifts of traditional clothing. They requested our input into how we experienced their church and what they might do better. They were grateful for our time there and wanted to let us know that they would love to collaborate with our churches back in the US much like the Australian church had done when they adopted the church as their Compassion church.
We capped off our last day by having dinner one last time with Charlie and Dee, once again with such wonderful food and conversation. Memar is thinking (at 9 years old) that she might want to be a doctor. She even came one day to the hospital to see what I did. She commented, “It was really dirty!” Dee assured Memar that all hospitals were not like that and that maybe Memar could come shadow me in the hospital in the US. Dee told me of a conversation she had had with Memar one night as she was putting her to bed.
Memar: “Could I be a cook?” Dee: “Sure!”
Memar: “Could I be a teacher?” Dee: “Of course!”
Memar: “Could I be a doctor?” Dee: “Yes, Memar, you can be whatever you want to be!”
Memar: “YES!” giving a fist pump. “Ok, goodnight Dee!”
It is inspiring to hear how their adoption of her is making her world so much bigger!
As they walked us back to the main road where we met our landlord for our ride to the airport, Dee whispered in my ear that they had just received the final confirmation that Memar was theirs! They had not told Memar yet, but the adoption was final! It was such an exciting moment, and we hope that when they come back to the US, we will be able to connect with them once again.
Tuesday we were monitoring laboring patients in the maternity ward when the midwives motioned for me to come examine a new arrival. Clearly, an umbilical cord was hanging out. Retained placenta? That was just the beginning. Her referral form stated, “blah blah health center referred to Any Hospital for retained twin.” She had delivered her first twin on Sunday, and now it was Tuesday! On exam, her amniotic sac was intact. I held my breath, and listened for a heartbeat. It was there- on day three after his brother or sister entered the world!! I wondered why she had waited so long to come to the hospital. “How far away does she live?” A midwife grabbed the chart, then said, “800 km.” A lightbulb came on. That’s why her referral form said, “To Any Hospital” and why she had taken so long to come.
Meanwhile, the laboring woman in the other room had prolonged 2nd stage (medicalese for: the part where the mom pushes the baby out). There were decelerations of the fetal heart rate (which can indicate fetal distress, head compression, or an umbilical cord wrapped around its neck, etc). Surely these patients warranted a phone call to the doctor! No, I was informed that they doctor would come around sometime after lunch, which was more than 3 hours away. Feeling helpless (we couldn’t give medications to speed up delivery without his signature), I watched over them carefully and then took my lunch.
When the doctor finally came, the first patient was given pitocin for augmentation of the delivery while we took the latter to c-section. This took an act of congress. (Actually, with the political process going the way it is, it was slightly less of a hassle.) We had to wait until the general surgeons were done with their current operations, wait for nurses to be available to get a stretcher, wait while the patient got onto the stretcher and was wheeled outside and through the other wards and into the OR. A live baby was born, although the baby was obviously distressed and took longer to breathe. Upon return to the ward, I checked on the woman with the retained twin. She had delivered! I peeled back the blanket to take a peek at the baby. I was startled to see the baby grunting, gasping for breath. I hurried to find the midwife. “What are we doing for that baby, the premature retained twin?” He looked at me, “Why? What’s wrong?” I answered, frustrated, “Did you examine him? He’s grunting, struggling to breathe!” He walked over and after looking at the baby, he stated, “We need to transfer him to the pediatric ward.” A little perturbed, I probed further, “Why wasn’t this done before?” He stopped in the hallway, but I motioned for him to continue, adding, “This is urgent! The baby cannot breathe!” He quickened his pace and explained, “There is no one in charge of the baby once it is delivered.” I was not satisfied. “But why was this not done immediately after delivery? Why did I find it just because I was curious to see her baby?” He repeated, “No one is assigned to the babies unless something is noticed at delivery. We are in charge of the mothers, and as you can see,” he motioned with his hand, “we have a lot of patients.”
In the end, no transfer was made because the mother had no one to support it financially and follow-up would have been necessary but impossible for this rural-dwelling woman who had travelled so far. I considered paying the $20 for the hospital stay of the baby, but I decided not to because after seeing the “Neonatal ICU” area which only had the capacity to put babies (unattended for the most part) wrapped and under light bulbs for heat with one oxygen tube and one NG tube (for feeding) and antibiotics. Even if they could have saved the little guy’s life, he would have been at risk of being in such a remote area as a premature infant. No, as hard as it is to stomach the statement, it was probably best to simply allow him to die peacefully next to his mother. And that’s what happened.
Comic relief
I had a few t-shirts which I rotated wearing with scrubs to go to work. As I was waiting for deliveries one day, the midwives were trying to remember my name. They said, “Is your name Dr. Sue-ez?” They got the S part correct, but I couldn’t understand how the rest of my name had been so mixed up. “You know, like the back of your shirt says,” one of them explained. Suddenly, I realized their confusion. My shirt had a quote on the back with the author’s name written underneath.
“A person is a person, no matter how small.” Signed, as you may have guessed it, Dr. Seuss.
I laughed so hard my sides hurt. “You think my name is Dr. Seuss? Haven’t you heard of the author who writes children’s books like ‘Green Eggs and Ham,’ ‘The Cat in the Hat,’ ‘Oh, the Places You’ll Go,’ and makes up silly drawings of animals/people?” Of course they hadn’t. But it made for a great laugh for me. I also thought to myself, What kind of person would wear a shirt with their own quote on it?
Lots of Tea!
It is a cultural formality to invite others to drink tea with you, so on my last day at the hospital and in Bahir Dar, we all drank many cups of tea and coffee. We had some in the morning with staff from the hospital, some at the Fistula Hospital, and in the afternoon I invited all of the students I had interacted with to come to a special tea to say goodbye to them. I was able to buy all 25 of them coffee, tea, or soda for about $7. Beautiful. We had a great time of reminiscing, they gave me a speech, and I was able to thank them for being my friends for the past 6 weeks, wishing them well in the rest of their careers. We took pictures and in general, it was a great way to wrap up my time in the hospital.
The leaders of the church invited Ryan and me to dinner with them. They presented us (especially Ryan) a certificate of thanks for his work in teaching at the Compassion program, coaching soccer, and donating soccer balls, clothing, and pens for their church. They also presented us with gifts of traditional clothing. They requested our input into how we experienced their church and what they might do better. They were grateful for our time there and wanted to let us know that they would love to collaborate with our churches back in the US much like the Australian church had done when they adopted the church as their Compassion church.
We capped off our last day by having dinner one last time with Charlie and Dee, once again with such wonderful food and conversation. Memar is thinking (at 9 years old) that she might want to be a doctor. She even came one day to the hospital to see what I did. She commented, “It was really dirty!” Dee assured Memar that all hospitals were not like that and that maybe Memar could come shadow me in the hospital in the US. Dee told me of a conversation she had had with Memar one night as she was putting her to bed.
Memar: “Could I be a cook?” Dee: “Sure!”
Memar: “Could I be a teacher?” Dee: “Of course!”
Memar: “Could I be a doctor?” Dee: “Yes, Memar, you can be whatever you want to be!”
Memar: “YES!” giving a fist pump. “Ok, goodnight Dee!”
It is inspiring to hear how their adoption of her is making her world so much bigger!
As they walked us back to the main road where we met our landlord for our ride to the airport, Dee whispered in my ear that they had just received the final confirmation that Memar was theirs! They had not told Memar yet, but the adoption was final! It was such an exciting moment, and we hope that when they come back to the US, we will be able to connect with them once again.
Tuesday, March 9, 2010
Circus Act II, What is the Point? And the Man who Loved Clowns
Circus Act II, What is the point? And the Man who Loved Clowns
Monday was a crazy day. If everything goes very smoothly, it will still be rushed. Am I crazy to try to do all this? I thought as we walked to the hospital that morning. I planned to obtain permission from the hospital administration for the clowns to come to the hospital that afternoon, participate in the Fistula cases in the morning, coordinate the clowns to come perform, arrange to go down the Nile River to see hippos, and cap off the day with dinner at Charlie and Dee’s with the clowns. Well, here goes nothing!
The first challenge was to explain what a clown was! I tried several words, acting them out, surely looking a bit silly to the first doctors I talked to as I pretended to juggle. Eventually, I figured out that some or most of them knew the word “circus.” Armed with that information, I went into the morning report. After the previous night’s admissions/deaths were reported, I said, “I have an announcement. With your permission, [administrator], a group of clowns from Italy are here… the circus is in town and would like to perform for the patients and their families. Would that be okay? Would you come and encourage your patients to come?” They smiled, looking at one another, and I knew I had my permission.
I hurried over to the Fistula Hospital, calling the clowns’ cell phone as I walked. They were performing at a school that morning, but they were available to confirm that they could come in the afternoon. We had 6 cases for surgery that morning, but after a few phone calls near lunchtime, I realized that I would have to skip the last couple in order to help the clowns find the hospital. I took the Bajaj to the Ghion Hotel where they were staying. I had assumed incorrectly that, being a large group, they had their own transportation. After all, they had ropes and unicycles and suitcases with juggling pins and hats and miniature musical instruments. In fact, they took the public transportation just like I did. What a site!! If I could have gotten this on video, you would fall on the floor laughing. Imagine 8 people dressed in weird black and white striped suits with unicycles and suitcases standing on the side of the road trying to hail the Bajaj’s. Imagine them trying to get in multiple Bajaj’s all destined for the hospital. Imagine the reactions of the other passengers as the strangely-dressed man brings an awkwardly big suitcase and a unicycle onto the small vehicle. A chicken, sure, but why would anyone bring a unicycle onto one of these, they probably thought. I got into one of them near the middle of the pack. I didn’t want them to feel lost once they got off at the hospital gate. Another guy was ensuring that the rest were able to get on other Bajaj’s. Halfway there, I noticed a clown standing on the side of the road with his suitcase. He looked slightly out of place, and a bit confused. I asked the driver to pull over. “What are you doing?” The clown said with an Italian accent, “They stopped, so I got out. Is this the hospital?” I stifled a laugh, looking at the area around which was mainly traditional mud houses and greenery. “No, the Bajaj will stop a lot for any of the people to get out wherever they want. You have to ride to the end to get to the hospital. Here, get in this one and I’ll catch another.” Oh boy. I had not been standing there long when a Bajaj filled with 3 of the clowns pulled up to the road. They were pulling money out to pay the driver when I stopped them. “No, no. This is not the hospital.” Obviously! I thought, looking around again. I smiled, thinking again just how funny this must look. “I just got out cause one of the clowns was standing here looking lost. I’ll catch another, just go to the end of the route! You can’t miss it!”
Finally at the hospital, we walked in the gate. The guard stopped them. I suppose they did look suspicious. I pulled out my white coat and put it on, thinking that this might be the only way I’d look respectable walking around with them. I explained to the guard that I had gotten permission from the administration. He insisted on searching their suitcases, a valid request. I’m sure he was puzzled to see the assortment of things they were carrying!
We chose an open area for the performance, and I led the clowns through the hospital wards, encouraging the patients or at least their families to come and follow the strangely dressed people. Many came out of curiosity. To my joy, nearly the entire patient population from the Fistula Hospital came walking down the road to the main government hospital to see the performance! They were dressed in brightly colored shawls, all carrying their catheters in the open buckets or just leaking on the ground where they walked. They were in a group, so they hopefully did not feel self-conscious about this. The clowns put on a wonderful performance, ad-libbing when vehicles or donkeys needed to come through their stage and through the crowd (we had chosen a road for the open area). The show had a distinctly different feel than the performance in the park on Saturday. Many of the on-lookers had wide eyes, some puzzled, some laughed hard. The audience at the park had mainly been city people, but this audience was mainly from rural areas with minimal exposure to any sort of performance. Several times we were asked, “What is the point?” One rural man got out into the middle of the performing area and started jumping up as high as he could and shaking his shoulders like they do in their traditional dances. The clowns didn’t miss a beat. They started jumping and shaking their shoulders as well. The crowd rolled with laughter at this.
After they finished their 45 minute formal performance, they took smaller items, puppets, and musical instruments through the wards to perform for the bed-ridden patients. Here, even one of the student health workers was hesitant to allow the clowns to visit. “What is the point?” we were asked again. He felt like perhaps they were making fun of the patients. “This is their job. Their job is to make people laugh. It is good for health too!” I explained. When he understood, he became very excited to watch and escort us to see his patients. The puppets climbed and fell down many IV poles, across many bedrails, shook many hands, ran into many windows and doors, and did acrobatic moves on patients’ beds. The clowns did a wonderful job of respecting the patients but also introducing them to a thing called silly laughter. One elderly gentleman was laughing before we even got to him. His family surrounded his bed, smiling broadly as they watched their sick loved one now heaving with laughter. Through the rest of the week, whenever I walked by him lying in a bed outside the surgical ward, he would greet me with a loud, “HEY!” waving with both hands and a grin on his face. He knew I had brought the clowns, and I was a hero ever after.
The Hippo Man
Since this was one of our last days in Bahir Dar, we wanted to take advantage of the Hippo Man, a guy who lives on the Nile River and takes tourists to see hippos for a small fee. I had arranged it the day before, but we had to run to get there in time, taking several Bajaj’s to the edge of town and walking through Bahir Dar University. Austin, Melissa, Ryan, and I took Memar (Charlie and Dee’s 9 yr old they are adopting). We joked around, Ryan chased Memar several times and carried her like a sack of potatoes, to her delight. The Hippo Man showed us the small tidy cinder-block house he lived in just on the banks of the Nile. Afterward, we piled in a metal boat with 2 men who paddled for us. We floated leisurely down the river, enjoying the lush scenery. Papyrus, tall hills on one side, distinct fields, paths with people and animals walking along filled our view. We went down a few rapids and around a few bends until, suddenly, we noticed that there were hippos right in the middle of the river where we were! We stayed near the edge, giving them ample room as they tend to be very territorial creatures. There were 6 in this bunch, but in the distance the Hippo Man explained that there was another group which was enemies to these 6. We stayed, watching as they dove under, surfaced, lifted their huge mouths and opened wide for us (unfortunately, they do this very quickly so our pictures have something to be desired). We enjoyed this glimpse of God’s creation, glad that we were safely on the banks and not swimming near them!
Dining with Clowns
We were exhausted after a full day and tempted to just go home for the night after seeing the hippos, but only for a minute. How often do you get to have dinner with 8 Italian clowns… in Ethiopia?? Dinner was wonderful, especially since I hadn’t been able to eat anything since breakfast because I was trying to coordinate their coming to the hospital. However, I have to say that the entertainment was even better. Have you ever wondered what clowns do when they’re bored? Surely, they didn’t get into their professions by being dull people. When they started to get restless, someone pulled out a huge bag of balloons, and they spent the rest of the night making ridiculous animals and objects, acting out stories with them. Their first animal, proudly made by one of the clowns for Memar, the 9 yr old Ethiopian, was a pig. Only one problem: Ethiopia doesn’t have pigs. “Aaeeeennt, strike one,” someone across the room yelled. The clown threw his work of art up in the air in mock surrender. “That’s kinda like when we acted out a whole story about chickens earlier and were flapping our arms with our hands under our armpits, only to find out at the end that people weren’t laughing because that’s not how they act out a chicken here. Here you have to move your head and chest like a chicken who’s strutting along. No wonder they weren’t laughing! And now I just made a pig… which doesn’t exist for them!” I guess there is a culture barrier to comedy as well.
As we all walked back to our house that night (which takes a good 30-45 minutes from Charlie and Dee’s), Ryan slung his arm around me and asked, “How’s my Facilitator today?” Exhausted. Happy. Tired of smiling. But oh so grateful for such a full day of laughter.
Monday was a crazy day. If everything goes very smoothly, it will still be rushed. Am I crazy to try to do all this? I thought as we walked to the hospital that morning. I planned to obtain permission from the hospital administration for the clowns to come to the hospital that afternoon, participate in the Fistula cases in the morning, coordinate the clowns to come perform, arrange to go down the Nile River to see hippos, and cap off the day with dinner at Charlie and Dee’s with the clowns. Well, here goes nothing!
The first challenge was to explain what a clown was! I tried several words, acting them out, surely looking a bit silly to the first doctors I talked to as I pretended to juggle. Eventually, I figured out that some or most of them knew the word “circus.” Armed with that information, I went into the morning report. After the previous night’s admissions/deaths were reported, I said, “I have an announcement. With your permission, [administrator], a group of clowns from Italy are here… the circus is in town and would like to perform for the patients and their families. Would that be okay? Would you come and encourage your patients to come?” They smiled, looking at one another, and I knew I had my permission.
I hurried over to the Fistula Hospital, calling the clowns’ cell phone as I walked. They were performing at a school that morning, but they were available to confirm that they could come in the afternoon. We had 6 cases for surgery that morning, but after a few phone calls near lunchtime, I realized that I would have to skip the last couple in order to help the clowns find the hospital. I took the Bajaj to the Ghion Hotel where they were staying. I had assumed incorrectly that, being a large group, they had their own transportation. After all, they had ropes and unicycles and suitcases with juggling pins and hats and miniature musical instruments. In fact, they took the public transportation just like I did. What a site!! If I could have gotten this on video, you would fall on the floor laughing. Imagine 8 people dressed in weird black and white striped suits with unicycles and suitcases standing on the side of the road trying to hail the Bajaj’s. Imagine them trying to get in multiple Bajaj’s all destined for the hospital. Imagine the reactions of the other passengers as the strangely-dressed man brings an awkwardly big suitcase and a unicycle onto the small vehicle. A chicken, sure, but why would anyone bring a unicycle onto one of these, they probably thought. I got into one of them near the middle of the pack. I didn’t want them to feel lost once they got off at the hospital gate. Another guy was ensuring that the rest were able to get on other Bajaj’s. Halfway there, I noticed a clown standing on the side of the road with his suitcase. He looked slightly out of place, and a bit confused. I asked the driver to pull over. “What are you doing?” The clown said with an Italian accent, “They stopped, so I got out. Is this the hospital?” I stifled a laugh, looking at the area around which was mainly traditional mud houses and greenery. “No, the Bajaj will stop a lot for any of the people to get out wherever they want. You have to ride to the end to get to the hospital. Here, get in this one and I’ll catch another.” Oh boy. I had not been standing there long when a Bajaj filled with 3 of the clowns pulled up to the road. They were pulling money out to pay the driver when I stopped them. “No, no. This is not the hospital.” Obviously! I thought, looking around again. I smiled, thinking again just how funny this must look. “I just got out cause one of the clowns was standing here looking lost. I’ll catch another, just go to the end of the route! You can’t miss it!”
Finally at the hospital, we walked in the gate. The guard stopped them. I suppose they did look suspicious. I pulled out my white coat and put it on, thinking that this might be the only way I’d look respectable walking around with them. I explained to the guard that I had gotten permission from the administration. He insisted on searching their suitcases, a valid request. I’m sure he was puzzled to see the assortment of things they were carrying!
We chose an open area for the performance, and I led the clowns through the hospital wards, encouraging the patients or at least their families to come and follow the strangely dressed people. Many came out of curiosity. To my joy, nearly the entire patient population from the Fistula Hospital came walking down the road to the main government hospital to see the performance! They were dressed in brightly colored shawls, all carrying their catheters in the open buckets or just leaking on the ground where they walked. They were in a group, so they hopefully did not feel self-conscious about this. The clowns put on a wonderful performance, ad-libbing when vehicles or donkeys needed to come through their stage and through the crowd (we had chosen a road for the open area). The show had a distinctly different feel than the performance in the park on Saturday. Many of the on-lookers had wide eyes, some puzzled, some laughed hard. The audience at the park had mainly been city people, but this audience was mainly from rural areas with minimal exposure to any sort of performance. Several times we were asked, “What is the point?” One rural man got out into the middle of the performing area and started jumping up as high as he could and shaking his shoulders like they do in their traditional dances. The clowns didn’t miss a beat. They started jumping and shaking their shoulders as well. The crowd rolled with laughter at this.
After they finished their 45 minute formal performance, they took smaller items, puppets, and musical instruments through the wards to perform for the bed-ridden patients. Here, even one of the student health workers was hesitant to allow the clowns to visit. “What is the point?” we were asked again. He felt like perhaps they were making fun of the patients. “This is their job. Their job is to make people laugh. It is good for health too!” I explained. When he understood, he became very excited to watch and escort us to see his patients. The puppets climbed and fell down many IV poles, across many bedrails, shook many hands, ran into many windows and doors, and did acrobatic moves on patients’ beds. The clowns did a wonderful job of respecting the patients but also introducing them to a thing called silly laughter. One elderly gentleman was laughing before we even got to him. His family surrounded his bed, smiling broadly as they watched their sick loved one now heaving with laughter. Through the rest of the week, whenever I walked by him lying in a bed outside the surgical ward, he would greet me with a loud, “HEY!” waving with both hands and a grin on his face. He knew I had brought the clowns, and I was a hero ever after.
The Hippo Man
Since this was one of our last days in Bahir Dar, we wanted to take advantage of the Hippo Man, a guy who lives on the Nile River and takes tourists to see hippos for a small fee. I had arranged it the day before, but we had to run to get there in time, taking several Bajaj’s to the edge of town and walking through Bahir Dar University. Austin, Melissa, Ryan, and I took Memar (Charlie and Dee’s 9 yr old they are adopting). We joked around, Ryan chased Memar several times and carried her like a sack of potatoes, to her delight. The Hippo Man showed us the small tidy cinder-block house he lived in just on the banks of the Nile. Afterward, we piled in a metal boat with 2 men who paddled for us. We floated leisurely down the river, enjoying the lush scenery. Papyrus, tall hills on one side, distinct fields, paths with people and animals walking along filled our view. We went down a few rapids and around a few bends until, suddenly, we noticed that there were hippos right in the middle of the river where we were! We stayed near the edge, giving them ample room as they tend to be very territorial creatures. There were 6 in this bunch, but in the distance the Hippo Man explained that there was another group which was enemies to these 6. We stayed, watching as they dove under, surfaced, lifted their huge mouths and opened wide for us (unfortunately, they do this very quickly so our pictures have something to be desired). We enjoyed this glimpse of God’s creation, glad that we were safely on the banks and not swimming near them!
Dining with Clowns
We were exhausted after a full day and tempted to just go home for the night after seeing the hippos, but only for a minute. How often do you get to have dinner with 8 Italian clowns… in Ethiopia?? Dinner was wonderful, especially since I hadn’t been able to eat anything since breakfast because I was trying to coordinate their coming to the hospital. However, I have to say that the entertainment was even better. Have you ever wondered what clowns do when they’re bored? Surely, they didn’t get into their professions by being dull people. When they started to get restless, someone pulled out a huge bag of balloons, and they spent the rest of the night making ridiculous animals and objects, acting out stories with them. Their first animal, proudly made by one of the clowns for Memar, the 9 yr old Ethiopian, was a pig. Only one problem: Ethiopia doesn’t have pigs. “Aaeeeennt, strike one,” someone across the room yelled. The clown threw his work of art up in the air in mock surrender. “That’s kinda like when we acted out a whole story about chickens earlier and were flapping our arms with our hands under our armpits, only to find out at the end that people weren’t laughing because that’s not how they act out a chicken here. Here you have to move your head and chest like a chicken who’s strutting along. No wonder they weren’t laughing! And now I just made a pig… which doesn’t exist for them!” I guess there is a culture barrier to comedy as well.
As we all walked back to our house that night (which takes a good 30-45 minutes from Charlie and Dee’s), Ryan slung his arm around me and asked, “How’s my Facilitator today?” Exhausted. Happy. Tired of smiling. But oh so grateful for such a full day of laughter.
Thoughts from Ryan, Part III
Ryan’s Observations part 3
-After touring the churches in Lalibela we went to the top of a hill to look over the view of the town of Lalibela. It is here I met a man who was 25 years old. He was only in the 10th grade because of his family situation. He is the oldest of 6 children. The family is poor and lives as farmers about 55 km from town. His father died about 2 years ago when the river water washed him off his feet and downstream to his death, so now he is trying to learn enough to become a tour guide. He came to Lalibela to get his education. He started school at age 15. He is separated from his family and often does not have the money to pay for his meals or rent (95 birr/month or about $7) so he skips classes in order to work for shop keepers to make money for bread for food. The school provides pens and notebooks and occasionally books, but nothing else. He said many of his friends have sponsors who help them with their living expenses while they get through school.
-One thing I find I have more of here is time to think. It is nice to sit at the end of my day and think about the day. This is something I rarely do in the US with all the ‘entertainment’ to keep my mind occupied.
-When dealing with the people, I often wish I could just tell them how things ‘should be’ and do it for them, but I think that this may only help them once and not allow them to develop their own thoughts and ideas. It is also somewhat arrogant of me to think that the way we do things in America is the best. Yes America is a great place, but it is not without its faults. Ethiopians have their own culture and ways of doing things and who is to say that they need to do everything like America or whichever developed nation is trying to solve some problem. I think the people here need to take responsibility to improve their own situation. Like the stories of Miles Standish and the Pilgrims, those who did not work did not eat.
-Ultimately, the question I struggle with is, “How do you instill a sense of drive and personal responsibility into a people who appear to have so many obstacles (education, government, $, etc) and crutches (Foreign Aid)?”
-I met a student who graduated from Gondor University with a degree in Environmental Health and Safety. He told me that he does not use his degree because no one will do anything to fix the problems when suggestions are made. As a result many who earn this sort of degree never use it. They end up working in some administrative role within the hospital.
-Dealing with a computer: I have learned that I have two pet peeves when dealing with computers in Ethiopia. First, when I turn a computer on here there are random empty folders and files created by someone but never named throughout the entire computer including the desktop, start menu, and my documents. For example, on the typical desktop I find about 4 new folders with nothing in them and a few word, excel, or PowerPoint files. Second, there appears to be absolutely no method to where files are placed and there are rarely folders created for organizing anything.
-Jose (an environmental health and safety officer/doctor from Spain) said he tells people they are ‘very important’ to the success of a given project even when they are not because if the people do not think they are personally involved in a project the job or equipment which is being proposed may not be completed or used and the next time Jose needs help the people will not want to help him. This leads to Jose shaking a lot of hands as we walk around the hospital and telling ‘everyone’ that they are very important to the success of whatever Jose is trying to get accomplished.
-Accountability and follow up is desperately needed when medical equipment is donated to a third world country like Ethiopia. We have been told there are crates of medical equipment that has been donated but is not being used. This is probably because no one wants to spend the money to transport the equipment to the hospital when in all likelihood the equipment will not be used because no one will know how to use or maintain it properly.
-Has American influence/aid contributed to the problem of begging and reliance on others in Ethiopia?
-Would an isolationist policy be better for the people in Ethiopia? (Shannon’s thought: it is puzzling to see how undeveloped the country is now when centuries ago they used to be very advanced for their time in building castles, rock churches, and elaborate palaces and tombs.)
-Could you build a private hospital and after a period of time have a graded transition back to the government regulation?
-After touring the churches in Lalibela we went to the top of a hill to look over the view of the town of Lalibela. It is here I met a man who was 25 years old. He was only in the 10th grade because of his family situation. He is the oldest of 6 children. The family is poor and lives as farmers about 55 km from town. His father died about 2 years ago when the river water washed him off his feet and downstream to his death, so now he is trying to learn enough to become a tour guide. He came to Lalibela to get his education. He started school at age 15. He is separated from his family and often does not have the money to pay for his meals or rent (95 birr/month or about $7) so he skips classes in order to work for shop keepers to make money for bread for food. The school provides pens and notebooks and occasionally books, but nothing else. He said many of his friends have sponsors who help them with their living expenses while they get through school.
-One thing I find I have more of here is time to think. It is nice to sit at the end of my day and think about the day. This is something I rarely do in the US with all the ‘entertainment’ to keep my mind occupied.
-When dealing with the people, I often wish I could just tell them how things ‘should be’ and do it for them, but I think that this may only help them once and not allow them to develop their own thoughts and ideas. It is also somewhat arrogant of me to think that the way we do things in America is the best. Yes America is a great place, but it is not without its faults. Ethiopians have their own culture and ways of doing things and who is to say that they need to do everything like America or whichever developed nation is trying to solve some problem. I think the people here need to take responsibility to improve their own situation. Like the stories of Miles Standish and the Pilgrims, those who did not work did not eat.
-Ultimately, the question I struggle with is, “How do you instill a sense of drive and personal responsibility into a people who appear to have so many obstacles (education, government, $, etc) and crutches (Foreign Aid)?”
-I met a student who graduated from Gondor University with a degree in Environmental Health and Safety. He told me that he does not use his degree because no one will do anything to fix the problems when suggestions are made. As a result many who earn this sort of degree never use it. They end up working in some administrative role within the hospital.
-Dealing with a computer: I have learned that I have two pet peeves when dealing with computers in Ethiopia. First, when I turn a computer on here there are random empty folders and files created by someone but never named throughout the entire computer including the desktop, start menu, and my documents. For example, on the typical desktop I find about 4 new folders with nothing in them and a few word, excel, or PowerPoint files. Second, there appears to be absolutely no method to where files are placed and there are rarely folders created for organizing anything.
-Jose (an environmental health and safety officer/doctor from Spain) said he tells people they are ‘very important’ to the success of a given project even when they are not because if the people do not think they are personally involved in a project the job or equipment which is being proposed may not be completed or used and the next time Jose needs help the people will not want to help him. This leads to Jose shaking a lot of hands as we walk around the hospital and telling ‘everyone’ that they are very important to the success of whatever Jose is trying to get accomplished.
-Accountability and follow up is desperately needed when medical equipment is donated to a third world country like Ethiopia. We have been told there are crates of medical equipment that has been donated but is not being used. This is probably because no one wants to spend the money to transport the equipment to the hospital when in all likelihood the equipment will not be used because no one will know how to use or maintain it properly.
-Has American influence/aid contributed to the problem of begging and reliance on others in Ethiopia?
-Would an isolationist policy be better for the people in Ethiopia? (Shannon’s thought: it is puzzling to see how undeveloped the country is now when centuries ago they used to be very advanced for their time in building castles, rock churches, and elaborate palaces and tombs.)
-Could you build a private hospital and after a period of time have a graded transition back to the government regulation?
Monday, March 1, 2010
A Valuable Rip-Off
Eager to get back to our work in Bahir Dar, we opted to fly back on Tuesday evening instead of taking another 12+ hour bus road on “the most dangerous roads in the world.” (According to some health source, this designation goes to Ethiopia, likely due to the mountainous terrain coupled with fast risky drivers and seemingly-oblivious pedestrians and livestock.) At the airport in Addis, we were advised during a friendly conversation with a guard that the restaurant in the parking lot would be much cheaper than going inside the airport building if we wanted a quick bite to eat before our flight. The menu was written only in Amharic, but as I scanned it, I noticed that it was very reasonably priced and no one item was above about 15 birr. We asked our waiter for suggestions and tried them—a plain egg sandwich, a burger, a coke and macchiato. Ryan commented as we finished, “This bill has got to be less than 50 birr or else they’re ripping us off.” To our surprise, not only was it above 50, it was 73 birr!! We reluctantly paid, thinking that perhaps the egg sandwich and burger were just not listed on the original menu. We questioned him, “Sentino burger?” “30.” “Sentino egg sandwich?” “25.” “Sentino coca?” “10.” “Sentino macchiato?” “8 birr.” The coca and macchiato were rip-offs. Even at the most expensive restaurants, macchiatos are 3 or 4, cocas are usually 5. Frustration! As we passed the guard again, he asked, “How was it?” I replied, “Good, but expensive!” His eyebrows shot up. “Really?” We mentioned the prices that the waiter quoted for the menu items and guard remarked, “Oh, he cheated you.” I began to be hopeful that some justice might be done. After all, the guard had a gun. I implored the guard to help us get to the bottom of the issue. It really wasn’t the money; rather, it was the principle of the Ethiopian way of charging more than double for taxis and food if you are a foreigner. The guard called our waiter over, asking him the prices. The waiter looked at his feet, sheepishly saying, “Macchiato 4, coca 5..” The guard turned to us, “So, he cheated you about 20 birr. How shall he repay you?” I looked at the guard, who genuinely looked sad. I said, “Give the guard and his 2 friends here all macchiatos for starters.” The guard responded, “And what about him… will you invite [the waiter] to join us? He is sorry.” We nodded in agreement. The waiter returned to get some birr to make up the rest of the difference. As he walked away, the guard commented, “He doesn’t earn a good monthly salary. He thought you were from Europe and just tourists.” The waiter came back to hand us 4 birr. I stuck it back in his pocket and said, “You take this, just please don’t do it again. Be fair.” We walked away, thinking about the guards getting their macchiatos, about the waiter perhaps learning a lesson about not cheating people or alternatively happy that he got away with it this time, and about us learning that people cheat us regularly because they likely aren’t paid well and tourists provide crucial income when they don’t question prices. In the end, I believe the guard was the cleverest. He pacified our desire to have someone on our side helping bring a cheater to some retribution and also kept peace with the waiter by including him in the macchiato party and by allowing him to still cheat us by more than 10 birr (He had actually charged more than 30 birr extra). The whole concept of Ethiopians’ acceptability of double standards in prices just because of the color of one’s skin still irks me, but at least the circumstances of one individual waiter brought the issue into better focus for me.
Back to work
Our detour to Addis had turned out about as good as one could hope as far as time away goes. We were back to work on Wednesday morning. Melissa and I were at the Fistula Hospital for 6 surgeries in the morning. Mid-afternoon, we took part in a party celebrating the hiring of a local Ethiopian surgeon full-time at the Fistula Hospital. They had a coffee ceremony, popcorn, and their “special occasion” bread (usually reserved for weddings and funerals). We went on a mini-safari after the party with a visiting surgeon. We pretended we were on a big hunt, ducking under coffee trees, over fences, traversing the fields near the lake filled with ibis, cows, horses, sheep, goats, storks and other random birds until we came near the edge of the lake where there were very large footprints in the mud. We all came to the conclusion that these had to be hippo footprints. Cool!
Thursday Melissa and I were in the government hospital operating room all day. A visiting plastic surgeon (from Addis) performed a few cleft lip/palate surgeries as well as a facial reconstruction, the general surgeon we were with did an open gallbladder surgery, an above-the-knee amputation, and removal of a goiter, and the ob/gyn’s occasionally interrupted the surgery schedule for c-sections for obstructed labor. After lunch, I was taken aback when one of the students approached me at brought up the subject of the situation I’d experienced near the beginning of my time regarding the drunken doctor. “You know, this happens sometimes,” the student commented, “and you should just forget it. You should not charge him. Then other people will think you are cruel. You should just forget it so there is nothing between you and him.” I was shocked. First, I did not know why he would tell me this unless what I had done was somehow unacceptable in their culture. Second, this meant that at the least, most of the students had heard about the incident. For me, though, I did not regret how I had handled the situation, regardless of “culture.” I explained, “I did not spread this, and I am not talking with anyone else at the hospital except I did tell his boss. I was uncomfortable in the situation, what he did was not good for the professions of doctors. Unless someone speaks up about it, it may continue to be accepted behavior.” I took a deep breath. “But, I do not have anything against him now and I am not charging him legally or anything. This was just between him, his boss, and me. If he was in trouble with his boss, maybe this will help him realize he needs to be careful about his behavior.” The conversation left me emotionally exhausted, but I was at peace with how I had handled the situation and hoped that whole ordeal could be finished.
The scare
What did we do before cell phones? We had to follow-through on plans to meet together and we had to make careful plans, both of which were off-target on Thursday night. With 4 of us now to coordinate schedules and only 1 house key and 1 cell phone, we have to communicate a lot before we leave the house in the morning. I ended up coming home alone to find no one. I knew Melissa and Austin were going on a date, and Ryan and I (I thought) would meet at home before going to eat out with someone from the church that night. I sat on the porch, reading and waiting for Ryan to get home on his bicycle from soccer practice. I finished an entire book, walked around, and I even walked to the street and asked random passersby to use their cell phone to call Ryan. No answer. After 2 hours, it was dark, and I was panicking. Tears streamed down a tired face as I thought about Ryan biking in a country with the “most dangerous roads in the world” and about how just 2 weeks earlier Berhanu (our landlord) had found out about his brother’s wife dying in a car accident from police who finally answered their incessant calls to her mobile phone.
Two and a half hours after I had come home, I was desperate. Even the guard who speaks no English was talking in Amharic to me like he was sorry for me. I asked him through gestures to come with me outside the gate again (in the dark this time) so that I could call Ryan again from a hitchhiked phone. Berhanu met us in his vehicle at the road, unexpectedly bringing us some water and bread on his way to visit family near our house. “What’s wrong?” he asked me. I told him my predicament and he offered me his phone. I called and Ryan answered! I was relieved, but confused. “Where are you?!” He had been waiting at the restaurant with the person from church, not wanting to leave in case I eventually showed up and running all of our conversations that day through his brain to figure out where I might have gone. He didn’t answer the first time because the phone was out of minutes and Austin and Melissa actually had borrowed the phone for awhile so that they could make a few important calls. In the end, no harm was done, but we are even more careful now to communicate and to check in when we can.
Blessed
Due to our unanticipated travel to Addis, our finances, our willingness to put ourselves at the mercy of more people who would hassle us and try to rip us off, our desire to stay over the weekend for Ryan’s soccer practices and church, and even our head colds, we decided not to join Melissa, Austin, and 2 others who were going to Gondor and the Simian Mountains to hike Friday-Sunday. Instead, I headed back to the hospital to see how many babies I could deliver. Jackpot! It was a holiday on Friday so it was only 3 midwives and me in the maternity ward. Miraculously, not a single baby died, and not a single mother had a tear during the deliveries. I delivered my first breech (butt first) and my first with an umbilical cord wrapped around her neck with minimal complications. I had never even seen a breech delivery much less be the one to do the delivery! Almost all will go to c-section in the US. I remembered to allow the baby to come out most of the way before touching it. Then, when I had the baby’s body in my hands, I froze for a second. What do I do now? How do I get the head out? There was no doctor around. I thought back to my “Intro to Global Health” course where we had been taught emergency obstetrics in limited-resource settings and even practiced on models. Confidence roared back and I gently coaxed the baby’s arm out. I began reaching to put my fingers in the baby’s mouth and over his cheekbones to flex the head when the mother helped me by giving a solid push and soon the baby was wriggling free in my arms. “Konjo lej!” Beautiful child. “Gibberish gibberish,” said the mother. The midwife translated, “She says ‘Thank you for your good care.’” I couldn’t help but smile big.
The midwives talked about our day during the downtime. “You are so lucky!” they exclaimed. Considering some of my other days here, I knew why they made that statement. I said, “Yes, we are blessed today.” They asked, “Did you pray this morning?” I nodded in affirmation. “You must have prayed a lot, because you are so blessed today!” I agreed, but I cautioned them. “Do you remember the story of Job in the bible? Do you remember when he said, ‘I am despairing of hope…’ and his life had just been basically ruined by the death of his children, the pillage of his livestock, and the sores which had come upon his body? Do you remember? He said right after that, ‘As for me, I know my Redeemer lives!’ So even though we say we are blessed for having this good day, we need to remember that even on our bad days when the babies are dying and there are complications that we are still blessed. Like Job said, ‘The Lord gives and the Lord takes away. Blessed be the Name of the Lord.’” I grinned. “But I agree: this is a blessed day!”
Clowning around
Saturday we both decided to be pathetic together. Our voices were raspy and slightly hoarse, a head-cold gone bad from our time in Addis. We both were coughing and hawking up lougies in the morning. I commented that Ryan had an unusually low voice, to which he replied, “bow-chika-bow-wow” or however you spell that. This is the first time in our marriage that we have been sick at the same time. (And yes, we are having a competition to see whose immune system will win first, and I think I’m ahead.) Obviously, the cold is more annoying than actually activity-prohibiting. We did our last load of laundry (for this trip) in the bathtub with bar soap and good ole elbow grease. Then, Ryan suggested we walk down the Nile River towards a palace of Haile Sallasie, one of Ethiopia’s former kings (and one of the kings nearly idolized by the Rastafarian sects). I was being my normal self and rushing at the beginning, knowing that if we didn’t hurry, we wouldn’t have time to go to a performance that night. Ryan patiently said, “We don’t need to conquer this. I just wanted to go on a walk with you.” Oh. Right. I could take a lesson from the Ethiopians who say, “We have no lack of time. We have a lack of money, but there is no lack of time.” So we slowed down, explored a monument to Martyrs during the time of the communist regime, walked through someone’s garden, took random rocky paths down to the Nile—stepping aside to let the cows with the horns walk by of course—to stumble upon Ethiopians bathing (oops), finally walking down a path with two shepherds (both about the age of 9) to a place where we could stop and just relax among the papyrus with the cool breeze off the river rushing by.
After returning to the city, we met our American friends (from the Clinton Health Foundation, CHF) to go to “the circus.” Apparently, the group Jokers Without Borders, was in town! It’s a clown group which travels internationally to lift spirits, release tension, and improve morale just as the group Doctors Without Borders travels to give emergency healthcare internationally. The Saturday market was crowded! No place was found to perform among the hundreds of people squatting next to their piles of tomatoes, potatoes, spices, mangos, etc, etc, etc. We headed to another location, then another before finally finding them in the city park near the lake. What a treat!! They wore black and white striped jumpsuits; their faces were not painted nor did they have wigs. They juggled, they fell down, they rode unicycles even with kids from the audience on their shoulders, they made music with random “instruments” (ping pong paddles, seed pods, xylophone, clappers) for almost a whole hour! One of my favorite acts was when the girl joker/clown balanced on what was essentially a loose thick rope tied between two trees, a slack rope. Then, she got on a unicycle on that slack rope, and then she balanced on all of that while juggling pins in the air. It was amazing. Secondly, I nearly died laughing when they brought a girl out of the crowd and one of the man jokers stood far away from her and pointed, “You, you you you!” Then, getting down on a knee, he said nasally, “I love you!” just like many of the local people do to us foreigners from a distance. The joker then balanced a long-stemmed rose on his nose and walked over to her. I went to the hotel in which they are staying today to ask if they might come to the hospital on Monday. They seemed excited about that possibility, and I am very excited that the patients and families might have a cheery day tomorrow!
In church this morning, I was struck by some of the kids in attendance. One less than 1 yr old looked around with big brown eyes, taking in the worship time from her perch over her mom’s shoulders. Kids danced in the aisles. One child, while breastfeeding, was clapping along with the songs. (They breastfeed longer here than in the US.) It was a stark contrast to the less than 1.5 yr old child sitting with his mother on the sidewalk who was guided by his mother to turn his tiny palm up for money when someone walked by. I am not speaking to their social status; I am speaking of how each is learning methods of behavior at a young age. Children seem to mimic actions that they see until they are old enough to judge for themselves. The next generation is being molded by the current behavior of their parents and the community at large. It takes a village to raise a child. What kind of village are we being for the next generation and for our kids?
After church, we went swimming! The Papyrus Hotel is one of two safe areas to swim in Bahir Dar (obviously not the lake!) Although you could not see the bottom, it seemed clean enough. It was a darker blue than normal and likely not chlorinated. It was refreshing but really cold! I had an informal diving contest with an Ethiopian. I let him win (although he would have beaten me eventually). The diving board was covered in a slick vinyl, so I opted not to run on it. Secondly, the board was made of two pieces and they were not firmly attached, making the end of the board very unsteady when I shifted my weight. We swam with Charlie and Dee, our CHF friends and unofficial mentors, and their 8 yr old adopted (from Ethiopia) daughter Memar. Memar has only swam three times, but she is pretty athletic and a daredevil. While walking away from the clowns yesterday, Memar was picking on Ryan and Charlie, so Charlie and Dee encouraged Ryan to carry Memar like a sack of potatoes. Memar started running, but she was no match for Ryan. He crouched down and weaved stealthily around several other people walking along the sidewalk before snatching her up and holding her, yelling, upside down over his shoulder. It was quite a scene, probably, if one had assumed that the Ethiopian child was not related to the 4 white forenji’s walking along. We got a kick out of one young man. “Is she your daughter?” he asked Dee. “Yes she is!” The man looked thoughtful. “But she does not have the same look as you.” Dee replied, incredulously, “Oh really? She looks the same to me!” holding her white arm next to Memar’s beautiful dark skin. We had a good laugh. Since Memar as declared that she wants to be a doctor someday, Dee asked me if Memar could come to the hospital this week just to see what I do. I think it will be great to have a 9 year old tag along, although I am hesitant to bring her to the maternity ward. Maybe we’ll just look at the newly born babies and skip the whole birthing part. It can be traumatic to see a birth under anesthetic much less a totally natural birth and women’s vocal response to that.
Melissa and Austin came back safely from the Simian Mountains tonight. We went to the Ghion Hotel for dinner, talking about our weekends. They thoroughly enjoyed themselves, talking about how it was comparable to the Grand Canyon, about the multitudes of baboons which they took pictures of, and of their hike to the second-highest peak in Ethiopia. I was a little jealous, but looking back on our relationships-filled weekend, I don’t regret our decision to stay. Ryan’s favorite part of the night was that there was a soccer game being shown while we ate dinner outside on a big white sheet big screen! There were at least 30 people eating and watching the game, and a monkey even joined the scene scampering up and down the trees around us just to make it interesting. Just clowning around!
Back to work
Our detour to Addis had turned out about as good as one could hope as far as time away goes. We were back to work on Wednesday morning. Melissa and I were at the Fistula Hospital for 6 surgeries in the morning. Mid-afternoon, we took part in a party celebrating the hiring of a local Ethiopian surgeon full-time at the Fistula Hospital. They had a coffee ceremony, popcorn, and their “special occasion” bread (usually reserved for weddings and funerals). We went on a mini-safari after the party with a visiting surgeon. We pretended we were on a big hunt, ducking under coffee trees, over fences, traversing the fields near the lake filled with ibis, cows, horses, sheep, goats, storks and other random birds until we came near the edge of the lake where there were very large footprints in the mud. We all came to the conclusion that these had to be hippo footprints. Cool!
Thursday Melissa and I were in the government hospital operating room all day. A visiting plastic surgeon (from Addis) performed a few cleft lip/palate surgeries as well as a facial reconstruction, the general surgeon we were with did an open gallbladder surgery, an above-the-knee amputation, and removal of a goiter, and the ob/gyn’s occasionally interrupted the surgery schedule for c-sections for obstructed labor. After lunch, I was taken aback when one of the students approached me at brought up the subject of the situation I’d experienced near the beginning of my time regarding the drunken doctor. “You know, this happens sometimes,” the student commented, “and you should just forget it. You should not charge him. Then other people will think you are cruel. You should just forget it so there is nothing between you and him.” I was shocked. First, I did not know why he would tell me this unless what I had done was somehow unacceptable in their culture. Second, this meant that at the least, most of the students had heard about the incident. For me, though, I did not regret how I had handled the situation, regardless of “culture.” I explained, “I did not spread this, and I am not talking with anyone else at the hospital except I did tell his boss. I was uncomfortable in the situation, what he did was not good for the professions of doctors. Unless someone speaks up about it, it may continue to be accepted behavior.” I took a deep breath. “But, I do not have anything against him now and I am not charging him legally or anything. This was just between him, his boss, and me. If he was in trouble with his boss, maybe this will help him realize he needs to be careful about his behavior.” The conversation left me emotionally exhausted, but I was at peace with how I had handled the situation and hoped that whole ordeal could be finished.
The scare
What did we do before cell phones? We had to follow-through on plans to meet together and we had to make careful plans, both of which were off-target on Thursday night. With 4 of us now to coordinate schedules and only 1 house key and 1 cell phone, we have to communicate a lot before we leave the house in the morning. I ended up coming home alone to find no one. I knew Melissa and Austin were going on a date, and Ryan and I (I thought) would meet at home before going to eat out with someone from the church that night. I sat on the porch, reading and waiting for Ryan to get home on his bicycle from soccer practice. I finished an entire book, walked around, and I even walked to the street and asked random passersby to use their cell phone to call Ryan. No answer. After 2 hours, it was dark, and I was panicking. Tears streamed down a tired face as I thought about Ryan biking in a country with the “most dangerous roads in the world” and about how just 2 weeks earlier Berhanu (our landlord) had found out about his brother’s wife dying in a car accident from police who finally answered their incessant calls to her mobile phone.
Two and a half hours after I had come home, I was desperate. Even the guard who speaks no English was talking in Amharic to me like he was sorry for me. I asked him through gestures to come with me outside the gate again (in the dark this time) so that I could call Ryan again from a hitchhiked phone. Berhanu met us in his vehicle at the road, unexpectedly bringing us some water and bread on his way to visit family near our house. “What’s wrong?” he asked me. I told him my predicament and he offered me his phone. I called and Ryan answered! I was relieved, but confused. “Where are you?!” He had been waiting at the restaurant with the person from church, not wanting to leave in case I eventually showed up and running all of our conversations that day through his brain to figure out where I might have gone. He didn’t answer the first time because the phone was out of minutes and Austin and Melissa actually had borrowed the phone for awhile so that they could make a few important calls. In the end, no harm was done, but we are even more careful now to communicate and to check in when we can.
Blessed
Due to our unanticipated travel to Addis, our finances, our willingness to put ourselves at the mercy of more people who would hassle us and try to rip us off, our desire to stay over the weekend for Ryan’s soccer practices and church, and even our head colds, we decided not to join Melissa, Austin, and 2 others who were going to Gondor and the Simian Mountains to hike Friday-Sunday. Instead, I headed back to the hospital to see how many babies I could deliver. Jackpot! It was a holiday on Friday so it was only 3 midwives and me in the maternity ward. Miraculously, not a single baby died, and not a single mother had a tear during the deliveries. I delivered my first breech (butt first) and my first with an umbilical cord wrapped around her neck with minimal complications. I had never even seen a breech delivery much less be the one to do the delivery! Almost all will go to c-section in the US. I remembered to allow the baby to come out most of the way before touching it. Then, when I had the baby’s body in my hands, I froze for a second. What do I do now? How do I get the head out? There was no doctor around. I thought back to my “Intro to Global Health” course where we had been taught emergency obstetrics in limited-resource settings and even practiced on models. Confidence roared back and I gently coaxed the baby’s arm out. I began reaching to put my fingers in the baby’s mouth and over his cheekbones to flex the head when the mother helped me by giving a solid push and soon the baby was wriggling free in my arms. “Konjo lej!” Beautiful child. “Gibberish gibberish,” said the mother. The midwife translated, “She says ‘Thank you for your good care.’” I couldn’t help but smile big.
The midwives talked about our day during the downtime. “You are so lucky!” they exclaimed. Considering some of my other days here, I knew why they made that statement. I said, “Yes, we are blessed today.” They asked, “Did you pray this morning?” I nodded in affirmation. “You must have prayed a lot, because you are so blessed today!” I agreed, but I cautioned them. “Do you remember the story of Job in the bible? Do you remember when he said, ‘I am despairing of hope…’ and his life had just been basically ruined by the death of his children, the pillage of his livestock, and the sores which had come upon his body? Do you remember? He said right after that, ‘As for me, I know my Redeemer lives!’ So even though we say we are blessed for having this good day, we need to remember that even on our bad days when the babies are dying and there are complications that we are still blessed. Like Job said, ‘The Lord gives and the Lord takes away. Blessed be the Name of the Lord.’” I grinned. “But I agree: this is a blessed day!”
Clowning around
Saturday we both decided to be pathetic together. Our voices were raspy and slightly hoarse, a head-cold gone bad from our time in Addis. We both were coughing and hawking up lougies in the morning. I commented that Ryan had an unusually low voice, to which he replied, “bow-chika-bow-wow” or however you spell that. This is the first time in our marriage that we have been sick at the same time. (And yes, we are having a competition to see whose immune system will win first, and I think I’m ahead.) Obviously, the cold is more annoying than actually activity-prohibiting. We did our last load of laundry (for this trip) in the bathtub with bar soap and good ole elbow grease. Then, Ryan suggested we walk down the Nile River towards a palace of Haile Sallasie, one of Ethiopia’s former kings (and one of the kings nearly idolized by the Rastafarian sects). I was being my normal self and rushing at the beginning, knowing that if we didn’t hurry, we wouldn’t have time to go to a performance that night. Ryan patiently said, “We don’t need to conquer this. I just wanted to go on a walk with you.” Oh. Right. I could take a lesson from the Ethiopians who say, “We have no lack of time. We have a lack of money, but there is no lack of time.” So we slowed down, explored a monument to Martyrs during the time of the communist regime, walked through someone’s garden, took random rocky paths down to the Nile—stepping aside to let the cows with the horns walk by of course—to stumble upon Ethiopians bathing (oops), finally walking down a path with two shepherds (both about the age of 9) to a place where we could stop and just relax among the papyrus with the cool breeze off the river rushing by.
After returning to the city, we met our American friends (from the Clinton Health Foundation, CHF) to go to “the circus.” Apparently, the group Jokers Without Borders, was in town! It’s a clown group which travels internationally to lift spirits, release tension, and improve morale just as the group Doctors Without Borders travels to give emergency healthcare internationally. The Saturday market was crowded! No place was found to perform among the hundreds of people squatting next to their piles of tomatoes, potatoes, spices, mangos, etc, etc, etc. We headed to another location, then another before finally finding them in the city park near the lake. What a treat!! They wore black and white striped jumpsuits; their faces were not painted nor did they have wigs. They juggled, they fell down, they rode unicycles even with kids from the audience on their shoulders, they made music with random “instruments” (ping pong paddles, seed pods, xylophone, clappers) for almost a whole hour! One of my favorite acts was when the girl joker/clown balanced on what was essentially a loose thick rope tied between two trees, a slack rope. Then, she got on a unicycle on that slack rope, and then she balanced on all of that while juggling pins in the air. It was amazing. Secondly, I nearly died laughing when they brought a girl out of the crowd and one of the man jokers stood far away from her and pointed, “You, you you you!” Then, getting down on a knee, he said nasally, “I love you!” just like many of the local people do to us foreigners from a distance. The joker then balanced a long-stemmed rose on his nose and walked over to her. I went to the hotel in which they are staying today to ask if they might come to the hospital on Monday. They seemed excited about that possibility, and I am very excited that the patients and families might have a cheery day tomorrow!
In church this morning, I was struck by some of the kids in attendance. One less than 1 yr old looked around with big brown eyes, taking in the worship time from her perch over her mom’s shoulders. Kids danced in the aisles. One child, while breastfeeding, was clapping along with the songs. (They breastfeed longer here than in the US.) It was a stark contrast to the less than 1.5 yr old child sitting with his mother on the sidewalk who was guided by his mother to turn his tiny palm up for money when someone walked by. I am not speaking to their social status; I am speaking of how each is learning methods of behavior at a young age. Children seem to mimic actions that they see until they are old enough to judge for themselves. The next generation is being molded by the current behavior of their parents and the community at large. It takes a village to raise a child. What kind of village are we being for the next generation and for our kids?
After church, we went swimming! The Papyrus Hotel is one of two safe areas to swim in Bahir Dar (obviously not the lake!) Although you could not see the bottom, it seemed clean enough. It was a darker blue than normal and likely not chlorinated. It was refreshing but really cold! I had an informal diving contest with an Ethiopian. I let him win (although he would have beaten me eventually). The diving board was covered in a slick vinyl, so I opted not to run on it. Secondly, the board was made of two pieces and they were not firmly attached, making the end of the board very unsteady when I shifted my weight. We swam with Charlie and Dee, our CHF friends and unofficial mentors, and their 8 yr old adopted (from Ethiopia) daughter Memar. Memar has only swam three times, but she is pretty athletic and a daredevil. While walking away from the clowns yesterday, Memar was picking on Ryan and Charlie, so Charlie and Dee encouraged Ryan to carry Memar like a sack of potatoes. Memar started running, but she was no match for Ryan. He crouched down and weaved stealthily around several other people walking along the sidewalk before snatching her up and holding her, yelling, upside down over his shoulder. It was quite a scene, probably, if one had assumed that the Ethiopian child was not related to the 4 white forenji’s walking along. We got a kick out of one young man. “Is she your daughter?” he asked Dee. “Yes she is!” The man looked thoughtful. “But she does not have the same look as you.” Dee replied, incredulously, “Oh really? She looks the same to me!” holding her white arm next to Memar’s beautiful dark skin. We had a good laugh. Since Memar as declared that she wants to be a doctor someday, Dee asked me if Memar could come to the hospital this week just to see what I do. I think it will be great to have a 9 year old tag along, although I am hesitant to bring her to the maternity ward. Maybe we’ll just look at the newly born babies and skip the whole birthing part. It can be traumatic to see a birth under anesthetic much less a totally natural birth and women’s vocal response to that.
Melissa and Austin came back safely from the Simian Mountains tonight. We went to the Ghion Hotel for dinner, talking about our weekends. They thoroughly enjoyed themselves, talking about how it was comparable to the Grand Canyon, about the multitudes of baboons which they took pictures of, and of their hike to the second-highest peak in Ethiopia. I was a little jealous, but looking back on our relationships-filled weekend, I don’t regret our decision to stay. Ryan’s favorite part of the night was that there was a soccer game being shown while we ate dinner outside on a big white sheet big screen! There were at least 30 people eating and watching the game, and a monkey even joined the scene scampering up and down the trees around us just to make it interesting. Just clowning around!
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