Thoughts from Ryan

I am learning more and more about the great need here in Ethiopia and it can feel overwhelming as I would like to help in so many ways. My first stop was the Kale Hewott Church. Upon arival I was introduced to a number of church leaders. I shared some of the areas I thought I could help such as sports ministry and teaching English, Math, and Science. At this point the church leadership and the Compassion International leadership began trying to pull me in different directions. However, they are very bad at providing a schedule and Icould have left that day without knowing anything concrete. Luckily, I met Trudi and Anthony, short term missionaries from Australia, my first day at the church. Trudi explained the culture and lack of organization to me and told the leaders that they needed to give me a schedule. Trudi later explained that she spent almost a month being frustrated by students not showing up to class and by classes being canceled or classes being rearranged last minute. She now has an understanding with one of the church leaders to tell her things straight up. The people here want to make foreigners happy so they say yes and nod there heads to everything you say, whether it is true or not. This is not so good when trying to get straight answers. Well, later that day at Trudi’s arranging, I met with the soccer director,the church director, and a compassion helper to set up a schedule. From that meeting I learned that I will be helping with soccer training and games of 4 soccer teams and teaching English and Physics. The leaders have also asked me since then to help them with their English.

That same day Shannon met two forengies (foreigners) at the hospital. One of them works with the Clinton Foundation, a group established byPresident Clinton to help HIV AIDS in Africa. He shared with me some of the problems his organization is working to solve, more about the culture here, and suggested some areas I might be of assistance at the hospital and with the Regional Health Beauro. He told me there are donors willing to give money to help the hospital, but the hospital leadership is not organized enough to put together an organized proposal with a list of priorities. When asked what they need, they say everything. This is partly true. They need better medical equipment, better hospital beds, more doctors, more space, a better sewer system, medical supplies, better ways of organizing medical records, paved roads around the hospital, waiting areas for family,etc… It can be hard to determine priorities because everything is tied together. Here’s an example I saw.

Recently, the sewer system backed up and black water was sitting in the drains of the operation room. This shut down the OR for obvious sterility reasons. The reason the sewer system was backed up was 1)because it was poorly designed and easily gets clogged 2) and because the rural population does not know how to act on the hospital grounds. They use stones to wipe with in the bathroom and toss these into the sewer system. They also toss there garbage onto the ground which ends up in the sewer system. Additionally, the OR is in a drafty room that allows dust to flow through. Everytime a vehicle, person, or animal walks around outside, dirt can fill the air and go into the OR. On top of all this, the government does not give the hospital money to buy any capital equipment. The hospital only has its opperations budget which does not provide a good salary to the doctors who work there. The government also does not invest in hospital care. It invests in medical clinics which are able to treat 90% of most illnesses. Thus if you do not have a common illness such as malaria or typhoid you probably will not receive very good care.

The other forengie I met is a doctor from Spain who works for Spain’s equivalent of the CDC who has been traveling around to over 10 nations during his life helping however he can. He shared with me from his perspective and gave me a greater understanding of the problems at the hospital such as the sewer sytem example above. From what I can tell he goes around to various countries and tries to repair major problems in hospitals such as a bad sewer system or environmental health problems. He is supervising the efforts of an Ethiopian who is writing a proposal to bring aid into the hospital for various repairs such as new beds that are not falling apart and are propped up on rocks, overhead lighting since there is none in many areas, new flooring since the tile floors are chipped and broken. It seems so foreign to me, but the hospital does not have anyone in charge of environmental safety (clean floors, good lighting, visitor management) or computer maintaince (Anti-virus, hospital record data backups, accounting databackups). They have lost whole computers with all their files to viruses.

The need here is so great in so many areas. It can be very hard on someone with my personality who wants to fix everything. Dr. Browning (fistula surgen from Australia) gave me a good piece of advice. He said, “You just have to pick a need and do your best to help in that area”. That is good advice, but my heart breaks for the needs they have. I want to teach them so many things and help them in so many ways.

On another note, the Australian’s I met have told me about a collaboration they have with the church here in Bahir Dar. The church has a good leader with some passion and vision, which is rare in Ethiopia and something the Australian’s are very happy to have found. The Austrailian congregation has adopted the church. I like to think of it like they have a “Compassion” church. The Australian church financially supports the ministry of the Ethiopian church and regularly sends short term missionaries from its congregation to encourage, teach, and minister to the Ethiopians. It seems to be a good model. The church has a vision of starting a theology school on the church campus and start theology training in various areas of the region. The soccer ministry also reaches into the surrounding communities with over 1000 boys and girls playing in the under 13 years old , under 15, and under 17 teams.

Thanks for all your prayers!!! God is providing me some wonderful opertunities to learn about Ethiopia from experienced aid workers and missionaries and to serve the people. Below are just some of my notes from conversations and observations I have had while here so far.
-Ethiopia is the 10th poorest country in the world.
-Ethiopia could be considered a last frontier since no nation has ever truly colonized it.
-80 million people in Ethiopia and 2000 doctors
-Brain Drain – Doctors do not get paid by the government enough to stay in Ethiopia so they leave for the US or other countries which pay better
-Gondar Medical School in Ethiopia graduated 60 doctors last year and only 2 are still in Ethiopia. They leave to make more money in wealthier countries like the US.
-It is easier to build a hospital in Ethiopia than to staff it with doctors.
-In an area of 145,000 square km with a population of 20 million,there are 152 doctors. About 88% of the population is rural making patient care very difficult.
- A hospital in this area of northern Ethiopia delivers 30 babies a day in an area that has about 5000 births a day (The women typically deliver at home and any obstructed labor can easily become a life threatening event especially for the baby. Obstructed labor is also the major cause of obstetric fistula. For a video on obstetric fistula search for a video by NOVA called A Walk to Beautiful)
- There are only 4 hospitals which provide the capability to perform a caesarian section in an area of 20 million people.
-The hospital in Bahir Dar was built by the Germans in the 1950s for a population of 25,000. It now serves a city with a population of over 200,000 along with the surounding rural areas. The old hospital has led to a lot of problems with the sewer system as it often backs up and causes problems in surgery. Sterile environments thus are not very sterile and infections are more prevalent.
-Medical equipment comes to hospitals like Bahir Dar from all over the world making it a nightmare to repair and maintain if you are a biomedical technician. The equipment is also out dated. Their x-ray equipment is still done on film (not digital) without the help of an automatic processor.
-Preventative maintenance is not understood so things like hospital beds, computers, sewer systems, and medical equipment will break and either not get fixed or hault the operations of the hospital until they are fixed.
-No sense of urgency in their surgery department. They expect to die, and are happy if they live.
- The people are at work about 6 hours a day plus 60 holidays duringthe year. Our landlord, an Ethiopian, has a refrigerator repair shop and he does maybe 2 hours of work a day. That is just the culture here, I have wanted to say this is lazy but have been warned not to judge this as lazy because I do not truly understand the Ethiopian people and their condition.
-Society is much more about relationships so productivity suffers.
-Anthony and Trudi (Australian Short Term Missionaries) said they considered full time ministry, but because there 14 yr old could not get a good education in Ethiopia they only came part time. (Need for quality HS education)
-Ethiopia is one of the easiest places to adopt in the world. About 8-10 couples were adopting on our plane from the US
-The internet speed here is a dial up connection at 33.6 kb/s
-Dominant religion is orthodox church in Bahir Dar with some Muslim, Catholics, and a few protestants.
-There is no ability to think critically, so most people follow blindly the commands of the orthodox church. For example, someone said the protestant church where I am helping eats cats and the people just believed it.
-Teaching can be frustrating since Ethiopian students often time don’t show up because of holidays. There is no real schedule given to Western teachers trying to educate the Ethiopian students.
-Clinton Foundation has set up initiatives to provide cheap HIV AIDS medication, cheap medical testing for AIDS for remote areas, and clinics with fully trained and equipped facilities.
-Cultural, technical, medical, language, etc. are all factors in the complex nature of Ethiopia’s problems. There are so many problems here that the need can be overwhelming. Plus, the ability to solve problems is as complex as the problems.
-Communication with Ethiopians is difficult because they do not ask you to repeat yourself if they do not understand what you said. They just say yes they understand and go on. Communication skills must be clear and you must make sure they understand by asking them to repeat what you said or asking them questions to ensure they understand.