Ancient Kingdoms, the 8th Wonder of the World, and Unexpected Trouble(s)

It’s El Nino
We began last week with some trepidation. Melissa, my classmate from the US, was due
to arrive on Saturday night and our flight to Axum to begin our vacation week was early
Sunday morning. Judging from our own experience of jetlag, we were not sure that
Melissa would be keen on getting on yet another plane, or that Melissa would even
arrive. Her plane had been delayed each day of the previous week. Every day, I had told
my colleagues at the hospital that she was probably somewhere in the air by now. Every
day, I found out El Nino was not letting up and that two back-to-back blizzards had hit
Washington DC, making one of the local doctors at the Fistula Hospital joke, “Is Melissa
still stuck in the sky?” Needless to say, exactly 6 days, 1 hr and 15 minutes later than
expected, she landed in Bahir Dar. Because our Ethiopian contact for Medics Away was
tragically in Addis Ababa for the funeral of his brother’s wife (due to a car accident), Dr.
Browning generously offered to take us to pick her up from the airport. Melissa was a
great sport and she insisted that the short night of sleep (11pm arrival to 6:30am trip back
to the airport) would suffice. We began using her mannerisms when we encountered
“bummer” circumstances. She just shrugged and said, “It’s El Nino. What can you do?”
Ancient Kingdoms “It is legendary… legend has it.”

Our flight to Axum was, amazingly, ahead of schedule. We had to make 3 short flight
segments to get to the remote city of Axum in the north of Ethiopia. My expectations for
this stop on our tour of the northern historical part of Ethiopia were minimal. All I had
heard was that there were giant stelae (rock pillars) and the original Ark of the Covenant
in the city, but not much else. We were pleasantly surprised to be led by a very capable
guide to numerous sites. At nearly every venue, the guide would either say, “Legend has
it that…” or he would conclude, “This is legendary.” So take the rest of this description
with this “legendary” perspective in mind.

We saw a 10ft by 5ft pillar with engraved writing from the 4th-6th century AD which
contained Greek writing (I can confirm this), the ancient script of G’eez, and (another
ancient script I can’t remember). It was found in a farmer’s field and preserved by
enclosing it in a cement block building on the same place it was found. We looked down
at a tunnel many meters below the rocky surface which led to Eritrea, 170km away. ☺
The view at the top of this rocky, mountainous hillside was gorgeous. The mountains on
which the Ethiopians defeated the Italians rose up in defiance—jagged, somewhat green,
but never uniform or smooth. Ethiopia is the only country in Africa which was never
colonized and has always maintained its independence. Even so, I cannot help but thank
the Italians for giving Ethiopia pizza, an easy “goodbye” word in “Ciao,” and the
prevalence of spaghetti during their attempt to colonize.

We explored the tombs of Axumite kings. They reminded me of what I imagine the
tombs underneath the pyramids might look like, although I have never been. The sheer
size of the individual stones used to build the tombs, especially the “ceiling” stones, was
quite impressive, as was the engineering behind the way each stone locked with the next
using notches or angling them just right. Each tomb had multiple rooms used to store
treasures. They say 90% of Axum is unexcavated. As she peered into an additional,
unexcavated chamber of one tomb, Melissa let out a muffled scream and jumped down
from her perch. A bat flew out the small hole she had just had her face in near the top of
the ceiling. I grabbed the flashlight and looked myself, keeping my face at a slight
distance. Those are big bats! I thought better of it and just put my camera up to the hole
so that we could get some cool pictures without a close encounter of face vs. bat. We
climbed the steep stairs back up to daylight shortly after, as the newly-liberated bat was
now flying back and forth between the rooms of the tomb and was hard to avoid in the
close quarters.

We visited Queen Sheba’s bath, a large man-made pool which is larger than a basketball
court. From what we could both see on the steep sides as well as what our guide
explained, the water level ranged from 1 meter deep at the end of the dry season to about
8 meters deep in the rainy season.

The remnants of Queen Sheba’s palace were stunning. According to the guide, in that
time period, either they built using huge stones placed directly on top of one another or
they built using smaller stones with mud in-between. Queen Sheba’s palace used both
styles, but mainly the smaller stone approach. What used to be a two or three-story
structure was now just part of the first story, but it was intricate. There were the stones
leading up to her throne room, her “shower,” a partially-intact oven with the stones
making an arch, an elaborate drainage system, and about 40 rooms on the outside of the
palace. Queen Sheba was known for her wisdom, and when she heard of King Solomon,
she went to Israel to see for herself. Legend has it that she had a son by King Solomon
and he established the Solomonic dynasty (the longest continuous dynasty) which lasted
until the 1970’s when the King was killed at the hands of the communist Derg.

We visited tombs carved out of the rocky hillside dated to the time of Christ, 2000 years
ago. I could just imagine that this was the kind of tomb that Christ stayed in for 3 days. It
was also significant to see the lay of the land, the shepherds with their sheep, goats, and
cows, and to think of David writing Psalm 23.

Lastly (of potential interest to you, as we saw other random things), we saw the main
stelae field. The huge stones marked the sites of underground tombs and treasure. They
had been moved to the sites by the strength of elephants and men from a rock quarry
quite a distance and downhill from where their final resting place was. I suppose they
devised a way just as the Egyptians had when they built the pyramids. The largest had
fallen during its erection. It still lay there, intricately chiseled, broken in several HUGE
pieces. They say it weighs 500 tons, according to the guidebook. It was 33m tall and was taken from a quarry 4km away. I guess you’ll just have to see the pictures. We looked briefly at the tomb inside. It was larger (or perhaps more fully excavated) than the previous tombs, but similar in description. There were two other standing stelae which were the most impressive. Apparently, one had just been returned (in 3 pieces) by the Italian government in the Ethiopian Millennium (back in the European calendar Sept of 2008). They were at least 30 feet high, but again, our pictures will be more indicative. The resting place of the original Ark of the Covenant
was across the street from the stelae field, but we elected not to pay entrance fees to the
church as only 1 high priest/monk is allowed to see the Ark (that’s his job until he dies),
and anyway, who would want to be struck dead by sneaking a peek? It’s legendary.

The 8th Wonder of the World
Monday we flew to Lalibela, home to the famous rock-hewn churches. To roughly quote
our guidebook, “If any place would evoke feelings of divine intervention, Lalibela does.”
Indeed, many people say that if it were more accessible, it would have been named in the
7 Wonders of the World. When we landed, I began taking pictures of a beautiful
mountain in the near distance. One hour later, I realized that on that mountain was
Lalibela. It was a beautiful, steep drive along cliffs and switchbacks, albeit a bit further
than we thought to get to from the airport. At least it was a paved road. We got a hotel
room and a mid-afternoon lunch and decided to use the rest of the day to explore the
churches on our own. Our guidebook had warned us of the multitude of people wanting
to be guides, so we prepared to fend them off with, “We’re coming back tomorrow.”
Cleverly, we fended them off the next day with, “Oh, we were already here yesterday”
and we managed to get through the churches as we wanted to, cheaply, peacefully, and by
ourselves.

This was definitely the highlight of our trip as far as tourism goes. If there is anything a
person must see in Ethiopia, it is these churches. They are unbelievable. Indeed, the
explorer who first discovered them wrote little about them “because it seemed to me that
they will accuse me of untruth.” There are 11 churches in 3 locations. Hewn straight from
the rock, the Orthodox Christians say that angels helped the workers carve them in a very
short period of time. I knew the churches would be immense, but I hadn’t heard anything
about the system of cave-like tunnels with stairs and rooms and turns which connected
each of the individual churches so that the priests could move around without going up to
“ground level.” The great part about exploring these on our own was that we had no idea
where a tunnel would go, but we just used our flashlight and were happy to turn off into
random dark rooms to see where they might lead. It reminded me so much of
caving/spelunking in America. Some of the tunnels with stairs led to the top of the rock
face which was essentially ground level. Then we could see the churches from above. As
the trenches and courtyards around the church were sometimes 20-30 feet straight down
without railings, we heard many times, “Remember: don’t fall!” Haha. As if we could
forget.

Inside the churches, we took the advice of some other travelers to just spend time
reflecting. Each church was cool inside, like a cave. 4 feet of stone is a great insulator
against heat. We would take off our shoes (symbolic of shaking off the dust of this world)
and walk on the stone floor smoothed out by many many years of people walking on
them. It’s especially a unique place to visit because although they are an attraction for
tourists, each church is still active and functioning with many Ethiopian Orthodox
believers making pilgrimages to these churches for church celebrations, locals coming to
pray or worship (only tourists must pay an entrance fee), priests and monks chanting and
singing passages of the bible or other prayers. We enjoyed just sitting and listening to the
chatter, observing how the priests functioned, seeing young boys training to be priests
just like Samuel did, contemplating the paintings inside the church depicting different
bible stories or stories of the Ethiopian saints, listening to other tourists’ guides talk about
the church (for free ☺), reading portions of our bibles, and reading on our own about
each church as we found them from a book I bought at a souvenir shop.

One of our favorite experiences occurred in a small church. Ryan and I had taken seats in
the darkness, using our flashlight to see the faded paintings near the ceiling and the
different crosses carved on the stone pillars. After about 5 minutes, Melissa entered the
darkness from the bright afternoon sunlight outside. From across the room, the priest
sitting stoically and nearly motionless near the curtain separating us from the Holy Place
suddenly called out, “Boo!” to which Melissa jumped. He gave a toothy grin. Ryan,
Melissa, and I all looked at each other (once Melissa found us and her eyes adjusted) and
then Ryan asked the obvious question on our minds. “Did he just say that?” We had a
good laugh, noting that priests have a good sense of humor too.

Each church is unique, some hewn on all sides, some on three sides in a cave-like
atmosphere, some with wooden bridges over trenches to get to them, some small, others
huge. They were built in the 11th century The largest was almost exactly 37.5 feet tall,
110.5 ft long, and 77.75ft wide supported by 36 pillars on the inside and 36 pillars on the
outside. I know that pictures won’t do this experience justice, so perhaps you’ll just have
to make the trip someday yourself. It truly for me was a Wonder of the World.

Unexpected Trouble(s)
We left Lalibela on Wednesday, excited about the history and magnificence of the last
three days. We had also been able to hike a bit to see wonderful mountain views, drink
macchiatos, listen to local live music and see the local dances, and eat wonderful food.
We sat in the airport, and as our plane seemed more and more delayed, we reconsidered
our potential plans to arrive in Gondor and make a 4 day trek up to the Simien
Mountains. Because Melissa had just arrived, she had not been able to be at the hospital
or work with the patients, and she was rightly concerned about coming to Ethiopia to
learn and practice medicine. We made the decision to see the castles in Gondor for a
short time and then head back to Bahir Dar on a bus that evening. Perhaps we would hike
the Simiens just before we left Ethiopia. In addition, we had noticed during our flights
that our tourist visa was due to expire before we were to depart Ethiopia. Going back to
Bahir Dar early gave us some peace that we could take care of some of these issues.
Our plane was delayed a couple of hours, putting us in Gondor around 1:30pm. Taxis
were our only option, so we reluctantly walked to them to see if we could get a good
price. Yeah right. He quoted an outrageous (although maybe standard) price of 150 birr.
Our 1 hour trip to Lalibela appropriately would have cost 40 birr per person if our hotel
hadn’t provided it free. We asked the taxi driver just how far it was to the city centre. He
said, 20 km. Well, that is kinda far. We told him we had been in Ethiopia for a month
and that we were Habesha (local) and not forenji (foreigners). “We just want to go to
Bahir Dar where we have been working for the past 4 weeks,” I said. “That is the
Habesha price,” he insisted. I asked, “Why would you give a forenji a habesha price right
away?” to which the guy tried hard not to smile. I had him. We got him down to 120 birr,
still higher than we wanted, but 20 km is far and we didn’t have an option. We started
driving, bummed that he was so inflexible and tired enough to just want to go home.
LESS than 5 minutes later, we were at the minibus stop where the minibuses are that go
to Bahir Dar. “Please let us out,” I said. “We want to go to Bahir Dar.” He tarried, first
driving past the minibuses, but turning around when we kept insisting that we wanted to
go to Bahir Dar. We got out and I gave him 60 birr, half the agreed-upon price but more
than enough in our minds for a 5 minute drive. We could have walked to this in 10
minutes. He shoved it back in my hand. I responded by explaining, “You told us it was 20
km. That was not 20 km. We will give you 60 birr.” He saw his predicament. “No, I will
take you to city centre and you can get the minibus there. Get in,” he said, opening his
trunk. “No, you lied to us. And why would we go further away from Bahir Dar when this
minibus here is going to leave out of town now?” The same conversation, or a variation
of it, continued until there was an ever-growing swarm of people pressing in on us as we
stood between the taxi and the minibus. Soon, it swelled to at least 50 people, crowding
us so that we were unable to get back to the taxi even if we had wanted to. We kept trying
to give the taxi driver 60 birr, and he kept trying to get us to get in and make the journey
longer so that he could get 120 birr (although I’m certain the rest of the way was not
significantly further). Finally, for safety reasons, Melissa and I scrambled onto the
minibus bound for Bahir Dar to escape the horde of people. Ryan added 20 birr and
handed 80 to the taxi driver and got in the bus with us. Our hearts were pounding as the
minibus pulled out, lunch was forgotten, the castles of Gondor not enticing in the
slightest. We all just wanted to get out of Gondor as fast as possible. “That man just
ruined our day,” Melissa commented.

We had a 3 hour drive left to contemplate the situation. I regret telling him in such frank
terms in front of others that he had lied to us, yet that’s what we felt he deliberately did.
(We have experienced this also in Bahir Dar, know for hiking prices for tourists). I
wondered how many cultural faux pas we had made. Was that really the price? Was it
that different from Bahir Dar, a city the same in size and tourist attraction? Did we just
give foreigners a bad name? What was the right thing to do? More maddening for me,
how did this man expect to earn more in one 5-minute car ride than a doctor will make in
a whole day of hard work? What should have been our response to him?
It was a relief to get away from the crowd, but soon we had our own crowd on the
minibus. They are made to seat twelve, but the official law limits it to fifteen. At any
point in the journey, it stops to take more passengers or let someone off. At one point, our
twelve passengers had increased to twenty! Luckily for the driver, four were let off just
before a police checkpoint. Gruffly, the police officer ordered one passenger off and the
driver to the back to discuss something. After a brief discussion (only a warning this
time, we found out later), he returned to his seat and began slowly driving away. The
police officer turned his back, and the 16th passenger ran to hop back on, the door was
closed, and we were on our way. A jovial mood overtook the minibus. The driver
exchanged a laugh with the guy charged with opening and closing the door. I guess the
giddiness of getting the best of the police (in a small matter) is something that transcends
cultural borders. ☺

Bottoming out
Back in Bahir Dar, we felt at home. It was a relief to be back in a familiar city where the
Bajaj drivers knew me and shouted out, “Hospital?” before I had even reached them.
Melissa, ever the trooper and eager to start work in the hospital, came with me on
Thursday even though she felt nauseous. However, she was unable to finish work either
Thursday or Friday due to severe GI issues. I thought I might have to buy an IV at the
pharmacy to rehydrate her. This was the start of a low point in our trip. Melissa’s El Nino
struck again. I felt this was such a damper as I had been so excited to have another
classmate to experience the hospital environment, and I felt horrible that she had invested
so much time and money to come when so much had happened.

Secondly, as I said briefly when we made the decision to skip the Simien Mountains, our
tourist visa was going to expire Feb 24th, 9 days before we would leave. I was frustrated
that we had not seen that before, confused why we had not been given three months (as I
think I had last time when I was here for five weeks without issue), and I just hoped that
it would work out. Ryan spent much of Thursday going from place to place on his bike,
trying to see if there was anything we could do to get an extension. No dice. Friday
morning, as I pointed Melissa in the direction of home due to her sickness, I learned that
one of my friends and patients had broke her waters early (and would likely lose her
baby) and Dr. Browning confirmed our fears that we would have to go to Addis to get a
visa extension. I spent the rest of the afternoon fighting that by going to the immigration
office in Bahir Dar, checking internet sites, and calling the US Embassy and the Addis
Immigration Office. Going to Addis would not only be expensive, but time-consuming in
our precious few days left. Melissa’s fiancé was coming in on Sunday and would have no
one to show him around if we left. We were told the Immigration Office can take up to a
week to issue visa extensions, if they grant the extension at all. I kicked myself for not
checking the dates sooner. Why, when we are just trying to do good and help people do
the taxi drivers try to rip us off and government documents and policies make it so
difficult? The bright spot in this was that we were not in the Simien Mountains with
sickness and documentation issues. Thank you God!

To Addis we must go
Saturday, I tried to get bus tickets to Addis so that we could get their Sunday night to be
at the Immigration Office first thing on Monday morning. Just in case. You know, the
phrase, People can deal with adversity much more than uncertainty, is quite true. WE
battled whether we should just leave Ethiopia early or just stay in Addis for the rest of the
trip. Ultimately, Ryan’s first week to be fully booked with activities was going to be cut
very short, but we really could not afford a $450 fine per person or go to court for an
expired visa. So, to get bus tickets I went. Skybus, we heard, was the best with air
conditioning and a picnic lunch. After going to 3 places by bicycle before I finally found
the ticket office, I found out they were completely full. Selam bus? Completely full. Now
what? Minibuses are not a safe option for that distance. A man who said he was from
Dallas (and later showed me his drivers license to prove it) stopped me from desperation.
“We are in the same boat,” he said. “I need to get to Addis tomorrow too.” After ruling
out hiring a private car, I went with him to the bus station. He spoke in Amharic and
found a cheaper local bus company with room for us. He said they were crowded and not
very nice, but they were much safer than the minibuses and our only option, it seemed.
He helped me buy the tickets and told us to be at bus 2027 at 5am sharp departure. Well,
this would be an adventure if nothing else!

Really, it’s a God-thing we didn’t know what was going on in the morning. It was
nearing the “5am sharp” time and there was a large crowd around a mostly-closed gate to
the bus station. “Well, we need to get in that gate cause that’s where our bus is leaving
from.” Ryan, with his large backpack on took it as a challenge. “Well, ok!” He barreled
through the crowd and I followed in his wake. He even went right past the guy with a
large gun who was “guarding the gate.” The guard/soldier appeared to want to tell us
something, but visibly gave up. Finally, we were inside. We used our flashlight and the
helpful guidance of other bus drivers to find our bus number in the multitude of buses
lined up around the perimeter of the large bus yard. Our bus driver directed us on and
checked our tickets. He guided us to two prime seats at the front of the bus which
guaranteed Ryan leg room as the (gear shifter box) was there.

We sat, glad to be in the right place, but curious why we were the only ones here at 5am.
We placed guesses on when we’d actually leave (just as my family has a tradition of
creating a competition with prizes for the winner to who has come the closest to guessing
the correct arrival time to a vacation destination). With no one present, it didn’t look
promising. Was “African time” kicking in?

Soon, we got our answer. A lone man walked to the middle of the bus yard and blew a
whistle. We immediately heard the hum of voices, the slapping of feet on the ground, and
we watched as utter chaos took over the bus yard. Over 300 people, the very crowd we’d
pushed through at the gate, descended on the buses, vying for the best seats. Our eyes
widened as we silently knew what the other was thinking. That would have been us! That
should have been us! Can you imagine trying to find the right bus quickly in the dark
when no one is speaking English?? Thank you, God, for our ignorance!

The bus ride was long, a full twelve hours with only one short stop for a lunch/bathroom
break. It was amazing scenery; at one point, we drove across a vast gorge through which
the Nile River flows. The largest bridge in Ethiopia, finished just two years ago, is across
the Nile at that point. It was beautiful mountainous countryside as well! We brought our
lunch of bread, peanut butter, and honey. At the lunch stop, I stood to stretch and picked
up the sack with the food in it. It had broken where the spoon had punctured the thin
plastic. As I was figuring out how to hold or retie the sack, I looked down to see a (small)
cockroach scurry away from where I had temporarily put my banana peels. Whoa, guess I
shouldn’t put our food in a holey sack on the floor. I thought about having to hold in on
my lap for 6 more hours. Maybe I can tie it tightly and it will be okay. Scurry went the
cockroach the other way. Nevermind! My lap it is!

In Addis, we stayed at the SIM guesthouse, comfortable since I’d stayed there four years
ago, and convenient because it was only a 5 minute walk to the Immigration Office. We
were at the gate at 8 am, ready for whatever uncertainties might come once it opened at
8:30. “I wish we would have had the time to email and ask for prayer for this. This is
huge!” Ryan assured me, “Everyone is already praying. And God knows.”

Who moved my cheese?
The process to apply was anything but well-organized. We nearly sat in the wrong queue
more than twice. “That’s what’s going to kill us—standing in the wrong line for a long
time,” Ryan noted. With two of us, one could hold a place while the other sought more
info. We went from one building to another, one time even having to leave the grounds to
get a photocopy of our current visa at a local kiosk. Occasionally, our moving to another
building accomplished a step in the process. ☺ Thankfully, there was a woman from
Finland who knew the procedures vaguely and we followed her lead. Also a plus, the
power stayed on throughout the time we were waiting, making in possible to enter the
information into the computers and take pictures. Just as hope was bubbling up that we
may be done and paid up, a woman behind the desk looked at her watch and stated, “Ok,
you can come tomorrow and pick up your passports. Next!” What? We filed out of the
building, feeling deflated, like we’d just finished a complicated maze to be rewarded by a
sign saying, “Finish line. Someone moved the cheese. Come back another time.” Oh well.
At least it is only tomorrow and not next week or even a “no.”

Unexpected reunions
We headed back to the SIM house just in time for tea. I was floored. I realize the
missionary community is small, but come on! Sitting around the table, sipping tea, a
middle-aged man looked up. Sure enough, he was the same water engineer whom I’d met
4 years earlier on my first trip to Ethiopia! At the next table, Laura Niblack was having
tea. She was the nurse with whom I worked in Awanno 4 years ago and also “randomly”
saw among 22,000 other attendees to the 2006 Urbana Conference. What a great time to
rejoice and reminisce!

Peace at last
We hitched a ride around Addis with the water well engineer, enjoyed coffee and various
shopping areas. Tonight, as Ryan and I ate supper alone on the second story of a
restaurant overlooking several beautiful city streets, eating Ethiopian food we’d guessed
on since the menu was in Amharic, with no other foreigner in sight, with the American
song, “You’re so beautiful” playing in the background, I felt a peace wash over me. I
have felt like a lot of my expectations for this trip have not come to fruition, and there
have been roadblocks, El Ninos, deaths, frustrations, etc., but sitting there, I felt peace.
God is here, God is good! He protects, He is sovereign. Ryan, ever the man of few but
significant words, summed up his view in a candid statement: “I had no agenda when I
came on this trip, so things are pretty much going according to plan.” Touché.

Thoughts from Ryan, Part II

-Water and Electricity: I came home today thinking I would take a shower and write a blog, well when I got home I could do neither. The electricity was off and the water pressure was so weak that I could not even get enough water to boil on the gas stove. Then the electricity came on for about 15 minutes and slowly I saw the lightbulb above me fade until there was no electricity again. Eventually the electricity came back, but we are still waiting on good water pressure so we can use the water heater. We will use the water pressure we do have to fill some buckets of water that we can later boil for our shower.

-Soccer: A transforming force. I saw soccer ministry as a less meaningful ministry compared to providing health care, but I have learned that soccer in particular can have a substantial impact on the psyche of the people and in turn bring a community together to discuss new ideas and share information which can lead to increased health and commerce. In America sports seem like such a luxury, but I am coming to see that sport in the 3rd world is very much a unifying force. It allows young men to take aggression out in a controlled environment instead of roaming the streets looking for trouble. It teaches lessons of fair play and good sportsmanship. It can change a culture.

-Before the soccer ministry started (about 4 yrs ago) children would throw rocks at the church building and spit on kids who went to the protestant church.
-The soccer ministry at KHC has changed the communities’ perception of what a protestant church is and children from the community no matter their beliefs can play on the churches soccer teams.
-The coach told me he selects players based on these 4 criteria: 1)They must do well in school 2) They must not smoke, drink, steal, o rhave a consistently bad character (He gives allowances for some wrongs but not a pattern of wrongs) 3) They need to have some soccer skill/athletic ability 4) Honor their family

-The Orthodox Church: 90% of the community around Bahir Dar is Orthodox and most are not accepting of the protestant church. I have heard numerous stories of orthodox families disowning their children if they go to the protestant church. The Orthodox Church from what I have heard is very ritualistic and is led by the priests. The people may read the Bible, but most likely they blindly follow the priest’s words. There is very little if any critical thinking about what and why the people believe.

-Governmental Policies: A government bill/law (not sure if it has passed) is setting out to curb the pay to NGO workers (Non-governmental organizations). This bill will effectively shut down human rights efforts in Ethiopia. There will still be funding for things like AIDS work and health care, but any work that puts Ethiopia in a bad light around the world (such as statistics describing the poor living conditions) will probably be shut down.

-Land for building a hospital is easily leased by the government of Ethiopia, however the catch is that after 40 years the building goes back to the government. (Conversely, I heard that if the building is still being used after those 40 years the government will not take it over).

-The government appears to try to take any hospital that is earning a profit, but of course as soon as the government takes it over the hospital falls apart and the quality of care suffers.

-Advertising: New movies at the movie theater or new music in stores in Bahir Dar is commonly made known to the community by strapping a sound system of 4 crackling speakers to the roof of a van and driving around the city with the volume turned up as high as it can go and playing music or speaking through the microphone inside the van to inform people of the newest thing in media.

-Bahir Dar a city of about 200,000 has a total of 2 stop lights. Very few people have cars, most ride bicycles or ride the local taxi vans (made for 9 but typically rides 15) or three wheeled bajaj’s.

-40% of the population are children (<14 yrs)

-Weddings: In Bahir Dar, weddings are broadcast to the whole community. This is because a wedding caravan drives the bride and groom around the whole town blaring their car horns. This is also caught on film by a cameraman who rides at the front of the caravan and stands in the bed of a pickup to film the proceedings.

-Competent Doctors: The quality of training and education of the doctors appears to provide qualified doctors capable of providing quality care in Ethiopia, but the government does not provide the quality of facilities, equipment, and reimbursement that a doctor needs to feel any sense of honor in the care they provide. This causes doctors to leave the country or become subsistence doctors who are depressed and/or numb to the pain and death they experience so regularly. They find themselves doing just enough to get by because that’s all they have the resources to do and often that’s all they are expected to do.

-White Doctors: The doctors trained in Ethiopia are qualified and competent; however, it seems that the people of Ethiopia believe that only foreign doctors are competent. This leads to people not trusting Ethiopian doctors. Consequently, the people do not come to the hospitals to receive care when they need it.

-Computers and Viruses: I have had the chance to work on a number of computer problems while in Ethiopia. There is a lot of technology in the country, but there is not enough understanding about how to properly maintain and use the technology. Over the past few weeks, I have fixed a pink shaded monitor, taught the hospital admissions department how to merge two access databases so they can use more than one computer to enter patient data, worked on a CDMA internet access device, networked two computers so they can both use the CDMA device, and run, rerun, uninstalled, and installed antivirus software to fight off viruses on a number of different computers. I am still waiting to hear back from the hospital administration about getting an interpreter to help me take an inventory of the computers at the hospital and update and scan the computers they have. (Shannon's note: Dr Andrew at the fistula hospital said this morning, "Your husband did a marvelous work on our computers.")

-Antivirus: The antivirus problem here seems astronomical especially since I do not have a quality program and the computers never have updated antivirus software. I have used freeware which incidentally takes at times an hour to download 20 MB. The installation and scan then takes another couple of hours by which time half the working day is gone. USB flash drives only make the problem worse by spreading viruses, something I found out first hand when the USB drive I was using to install antivirus software on computers without internet connections became infected. I am not sure why, but no one ever updates their antiviruses here. So any new virus not in the old database, easily finds its way onto the computer.

-Education: The past two days I have taught English to about 35-40 5th and 6th graders and 8-12 7th and 8th grade students. I assume that many of the students drop out of school after 6th grade, but I am not sure. The thought of me teaching English (probably my most disliked subject in school) is slightly amusing to me. I think God has quite a sense of humor sometimes. My classroom has one blackboard, a few windows to let light in, and a number of benches with desks that seat 3 students each. The students do not have any textbooks, only some beat up notebooks and pens, so as their teacher, I provide the text/lesson by writing everything up on the chalkboard. No fancy projector or even the old overhead projectors, just good old fashion chalk. It is hard to know where to begin because the ability of the leadership to clearly communicate with me what needs to be taught is nonexistent. I have been working on teaching them the differences between nouns and verbs and some other grammar while trying to teach vocabulary and pronunciation. Fortunately, I have a translator who helps me with my classes, otherwise I do not think the students would understand me and I certainly would not understand their Amharic. I had hopes of teaching them math, physics, chemistry, and biology, but the students would not understand the English I used to teach them these things, so until they learn English they cannot learn the other subjects. Apparently, in high school all the textbooks are in English which often causes many students to drop out because they did not learn enough English to understand the texts. (Shannon's note: Ryan is planning to tutor some of the local high school students individually in math and physics. Apparently these are the highly motivated and also more English-fluent students.)

Chigger Yellum

The phrase “chigger yellum” (transliterated into English from Amharic script), is equivalent to saying “Hakuna Matata” in Swahili, “No worries mate” in Australian English, and “No problem” in American English. I feel I owe the readers of this blog a respite from some of the harsh realities we have encountered. Call it comic relief. At any rate, I hope this is a more light-hearted look at our time here.

When we first arrived, we took special notice of how the local people dressed in order to know what was appropriate. Ryan commented that he apparently needed to carry a big stick and wear a poncho in order to wear shorts. Indeed, every man who we identified with shorts was engulfed in layers of cloth which he wore like a poncho with the point hanging down to his thighs and the widest portion over his shoulders. Almost without exception, the man would be carrying a staff, a stick, a gun, a cane, or even a piece of rebar slung over the shoulders or sticking out from underneath the poncho.* Surprisingly, Ryan elected to wear pants.

Apparently, knowing your weight is big business. These entrepreneurs don’t even have to guess your weight (as in a carnival or fair in the US) to be paid. They only have to supply the scale. Along the sidewalk, you may see 1-3 people with scales in the length of a city block. To get your attention, most tap their coins on the scale to make a tinking sound when you walk by. We were particularly impressed with one set of boys. They had rigged a toy siren to the side of their scale to avoid the difficult task of banging coins on metal. Instead of the normal tinking, we were treated to a flashing red light and a crackling wail of what sounded like a toy fire engine. You know, it almost convinced me that it was urgent that I find out my weight.

Sunday after church we ate at a restaurant next to Starbacks. That’s the correct spelling. Along with the round green logo with white writing, the name Starbacks sounds strikingly familiar. Apparently, there are a lot of familiar restaurants in Addis Ababa: Burger Queen, Starbacks, Kentacky Fried Chicken, MucDonalds. I haven’t personally seen all of these, but legend has it…

We walked home on Sunday, and I had my Bible in my hand. As happens frequently, a man started walking next to us, wanting to start a conversation with the forenji’s. He said, “Is that a Bible?” I nodded my head. “That’s very nice,” he commented. “Do you want one?” I asked. “Of course!” he answered, “I have none.” I inquired, “Is there a store which sells Amharic Bibles nearby? We’ll buy you one.” He was visibly excited. We were near one of the Orthodox churches, and I remembered that each time we passed near St. George’s, there were numerous tarps spread with books and posters and cross necklaces. When we arrived at one of the first tarps, the man began looking through the books. He picked up a couple. “Are those Bibles?” we asked, thumbing through them. “This is a prayer book,” the man answered, adding, “It is a good price.” I shook my head, “We would like to buy you a Bible. Are there any Bibles here?” Finally, after some searching, a nice leather-bound Bible with an Orthodox cross on the front was located. The man looked at us apprehensively. “It’s very expensive.” Selah ***

We had a great forenji soccer match on Sunday afternoon. There were 6 Australians including Dr. Andrew and his son, Anthony and his son, and Ryan and I were the token Americans. We played against an equal number of bible students from the Kale Hiwot Church** (KHC). The ground was rocky dirt with larger rocks for rough boundaries, and the goals were wooden poles nailed together. Ryan stole the show and scored at least 4 goals.

Amazingly, we have had only 1 power outage at our house. That night we decided that eating by candlelight and going to bed (very) early was about the only thing we could do. To my knowledge, I don’t know that I’ve been in bed with the first number on the clock reading 8 since before I was a teenager. Power outages, we decided, are good for marriages as well as for tired medical students.

Un-amazingly, we only had enough water pressure for the hot water heater in the bathroom to work for the first 4 days. Since then, we have enjoyed the convenience of boiling water on the stove for bucket baths using the bottom half of a plastic water bottle. Over the weekend, the water pressure in the city was definitely on vacation. It took over 30 minutes for me to fill the bathtub with 2 inches of water for washing clothes. I had fun, though I felt I was getting more water on me than was coming out of the faucet.

Today was a better day for me than Monday. Bear with me as I explain Monday’s events. In short, Monday was very difficult because I delivered a baby who died (likely had died in the womb shortly before she delivered). It was hard for me to face the mother when we had failed to resuscitate her baby. Secondly, I found out that a mother who had presented on Friday with prolonged labor and intrauterine fetal demise and a ruptured uterus died early Monday morning. We had performed a c-section and hysterectomy on Friday, but she was in septic shock after the operation. The doctor had stated on Friday that she had been neglected and her husband only brought her in when she failed to die. “How else would she not have received help for this long than she was neglected? The husband may have more wives at home or he may just get another younger one if she had died in childbirth. Anyway, the child was dead already.” Fast forward to today. I helped deliver the second twin which had been retained for about 3 hours after his sibling had arrived in the world. One dose of Pitocin was enough to give the mother a few contractions and the little boy came sliding right out. I taught one of the new mothers how to hold her new baby to breastfeed. Thankfully, I have been volunteering at the Seton Home for teenage mothers in San Antonio in their breastfeeding support group, so I have been taught many tips and helpful ideas. Generally the subject of breastfeeding is left up to lactation consultants in the US and many medical students and doctors receive relatively little information to share with patients. Lastly, I spent a good chunk of time teaching some of the other students. It was great practice for me to be able to explain how to determine dilation and effacement and station (pardon the medical-ese, those words just are used to describe how the labor is progressing). I also taught them about polyhydramnios (too much amniotic fluid around the baby) and discordant twins (one twin is significantly bigger than the other).

Yesterday, Monday, I brought 5 bars of soap into the maternity ward because there was no soap at any of the sinks. One of the midwives passed by me afterward, smiling and smelling her hands. “Infection control. Thank you very much!” Ironically, today I saw that both bars which were in patient areas were still at the sinks where I had left them, but none of the 3 bars remained which had been placed in the areas where the health workers and employees work. I told the doctor that I would replace them again tomorrow, but he said they need to investigate which workers had stolen the soap. “The patients likely did not take the soap out of respect for us.” He chuckled. “You know, sometimes they drill a hole through the soap and attach it to the sink with a rope to make sure it does not disappear.” It is amazing to me that something which cost me less than 50 cents could be so valuable that you need to secure it with a rope.

A thought by Ryan: -I find it ironic that there are people who sit on the main walkways around town who will wash and shine someone’s shoes (athletic or leather) or clean their bicycles, but when it comes to washing their bodies or their hands, they often do not take the time and effort to wash regularly or thoroughly.

Tonight we had a wonderful time at KHC. The church put on a bonfire party in honor of Anthony and Trudi and their family. First there was volleyball and then a gathering around a campfire as a second fire cooked 3 goats for a rare meal with meat. Genuine, though long-winded, speeches by the leaders of the church were made in gratitude for the Anthony and Trudi and for their church in Australia which has adopted KHC. Then, as a way to pray for the meal, we danced around the campfire to the beat of an African drum. When I used to think of Africa, this was one of the things I pictured in my mind, yet it took me three times to visit Africa before I finally was able to experience this. I love music and I imagine worshipping God in heaven will be similarly joyous and energetic and powerful. Ryan captured the dance on video, so hopefully we’ll be able to share this when we return home. The goat meat was wonderfully flavorful, and we even had caramel popcorn**** for dessert! It was a feast for sure and a day not soon to be forgotten!



*We found out later that this is simply the dress of rural farmers, regardless of the tribe from which they hail. The “big stick” is crucial to protect oneself from wild animals.

** KHC is the church which Ryan has been volunteering to teach and coach soccer at with the kids from Compassion International.

***Selah is a word used in the Bible which instructs the reader to stop and ponder (in my paraphrase). Of course we bought him the Bible, but it struck us that it is likely that few Orthodox Christians can afford to have their own Bible from which to study or check to see if the teaching of the church lines up with the Holy Bible, the word of God. Prayer books and pictures of saints are very available, but these are from the wisdom or creativity of man.

****Trudi actually taught a man to make caramel popcorn whose business was to make snacks to sell at the bible school and other places around town. Apparently, someone from the government tasted the popcorn that he made and liked it so much that the man was given a government award for innovation in entrepreneurship and given a new bicycle! It was tasty caramel popcorn!

Death and Destruction, a Dilemma, and a Disheartening Experience

Every morning, the doctors gather in the administration building. Those who have been working during the night will give a report to the hospital administrator and the rest of us (I have not figured out who everyone is, but most are doctors.) I have found that these morning reports are more like M&M conferences in the US—(I was telling this to Ryan at lunch and he said, “The chocolate with a candy coating?”
Me-“Very funny. No, M&M stands for morbidity and mortality. It’s wheresomeone presents a clinical case where the patient either died or hadsignificant morbidity (something went wrong) during their time in thehospital.”
Ryan- “Oh, so like death and destruction!”
Me- “Well…mortality is death and morbidity could be a destruction.” Smile.“Death and destruction, touché.”)
—Last week, they reported that a mother had died in childbirth in the town. I was shocked. She had post-partum hemorrhage, but she had already died by the time they brought her to the hospital. I knew that the maternal mortality rate was awful in Ethiopia and developing nations in general, but I had assumed it was because of lack of access to care. But here was a woman who lived in the town with a tertiary care center with the capability to do a c-section, and she still died. Also, this week, the morning report was cancelled once because all the doctors were treating casualties from an automobile accident. Today, they talked about a man who came from one of the monasteries on the lake with a volvulus (where the colon is twisted on itself and it obstructs the bowel). During a procedure to untwist it using a sigmoidoscope (fancy word fora device that snakes into the colon like a short version of acolonoscopy instrument), the man began bleeding. They needed to take him to the OR for a surgery to see if they had perforated the colon with the sigmoidoscope and to untwist the colon manually. The man refused and left the hospital.
-“Why did you not look through the sigmoidoscope to see if you had perforated the bowel?” one doctor asked.
-“There is no light on the instrument. It is very difficult.”
-“Why did you let him leave? If he left for religious reasons, that is okay, but it is unacceptable if he left due to financial reasons. He IS going to die. There is some kind of emergency fund for these cases.”
-“I don’t know. I wish we had a sigmoidoscope with a light. They have them in Addis.”

It was an interesting conversation. Most of the morning, I pondered the reasons for sub-optimal health care. The doctors here seem quite competent- they teach most of the same things I have been taught. However, the resources put into healthcare are abysmal. The doctors perforated the bowel last night because they lacked proper medical equipment. They use toilet paper to clean off a woman’s stomach after an ultrasound. Since the sewer system has backed up into some of the OR’s, they are doing surgeries with less space. They ran out of beds today in the hallway, so they put down a plastic mat for some of the patients. Come on! They are already in the hallway with a bed number written in magic marker on the wall above them, and now they don’teven get a simple mattress?? The doctors deal with a huge percentage of wound infections, not only because of lack of sterility (one confessed that there had been a cockroach running over the “sterile field” during surgery), but also because there is dust from the road not being paved outside and the windows being open to the surgical area. They use IV tubing for a tourniquet to insert IV’s. Some of the beds are propped up with rocks if the wheels have fallen off. Half of the surgical patients are in beds outside. At least they are covered by a roof, but they are still outside with new wounds from surgery.They use a space heater to keep the newborn babies warm after birth. Roughly 2/3rds of the sinks don’t work to wash your hands in- nothing like having alcohol dispensers outside of each patient room like in the US. The ceilings are high, but they are lit with only a row of single florescent bulbs, and half of them don’t work. If an emergency were to occur, it would be very difficult to get a patient onto a stretcher and maneuver past all of the patients in the hall, outside zig-zagging through multiple open courtyards and multiple hallways to finally get to the OR. There is one blood pressure cuff for the whole gynecology ward. If the patient needs medication, a prescription is written and their family has to buy it at the local drug store. It is not readily available for the doctors to administer if they need to do something quickly. It seems that healthcare here is subsistence healthcare (analogous to subsistence farming)- doing what they can to survive, to making do with what they have. It seems that there is no time for foresight into what improvements could be made. I have been told that the doctors are not paid a good salary- they can make more money even in other countries in Africa like neighboring Sudan orKenya. You can’t really blame 58/60 graduating doctors for leaving Ethiopia when they are not provided the tools nor the money to provide the care they know is best. Ethiopia does have great medical education and trains very smart doctors… exports great doctors. Retaining them is a different story.

I am facing a dilemma. Does a person work with the government to improve existing structures and institutions, or does a person forget about that and build a completely separate (and sometimes unsustainable) mission hospital? Does a person focus on one specific issue or work on the bigger picture? Mission hospitals are usually better funded (by donations to charity) and more efficiently-run. The fistula hospital is a mission hospital. Tenwek is a famous mission hospital in Kenya which does excellent work. But there is something to be said for working with the government to raise the level of care given to a great percentage of the population. It takes a great deal more patience and persistence, but I think a lot of good can come of it. Where as the Fistula Hospital treats one condition with excellence, they cannot address broader issues in healthcare. It is a shame we cannot provide the kind of care the fistula patients receive for the rest of the population. It seems it would be better to get a fistula during childbirth so that you could receive top-quality care than to only suffer a 3rd degree tear or have a rectocele (bulging of the rectum into the vagina) and have to stay at the government hospital. I know that one person cannot tackle all the problems, but I am glad that there are people and organizations like the Clinton Foundation and the Spanish one (name escapes me) which Ryan is working with to help solve some of the overall problems.

Ryan has gained the confidence of Jose, the doctor from Spain we mentioned earlier. Ryan taught some of the hospital staff a little bit about working with their database. They seemed to really benefit from that, and Jose started asking for advice/recommendations regarding the sewer system and anti-virus software for the computers and x-ray machine help. I’m really very proud of what Ryan is being asked to do for the hospital, and I am excited for the wonderful contacts we have met to make this possible. Thank you to all who have been praying for that specific prayer request. It seems that this has been answered in a mighty way!

I had a bit of a disheartening experience on the way out of the hospital today. God was protecting me. I was seeing a newly-admitted patient with one of the other students (an older, wise male student)and we finished a little later than usual. Since we were both walking the same way, we decided to continue our conversation on the walk. We took off our white coats and strode out of the hospital gate. We were deep in conversation when, out of one of the restaurants, walked one of the doctors whom I have worked with the most (and who has been the best teacher thus far). Something was wrong. He was dressed in plain clothes, and he had not been in the hospital that day. Had he not been someone I knew well, I would have been across the street to walk on the other side in a heartbeat. But I thought maybe he was coming towards us to greet us- although his gait was definitely unbalanced. I reached over to shake his hand, but soon, the other student stepped in-between us. The doctor began saying things, slurring his words, and nearly falling onto the student to get to me. His words were inappropriate. The student started walking faster, stoically looking forward. I followed his lead, and soon the doctor could not keep up. We did not look back, and we walked along for awhile- our friendly conversation forgotten. The student looked stern, angry almost. Finally, I stated the obvious, “So he was drunk.” Immediately the student said, still looking straight ahead, “I am so sorry. He should not have said that to you.” I pitied him. Surely, this must be the most embarrassing thing- to have a “respectable” teacher become despicable in front of a foreign visiting student. There is nothing quite like feeling you or your country will be judged by actions of people which are out of your control. “Is he depressed?” I asked,trying to make some excuse for his behavior, if only to ease the student’s discomfort. “Most likely.” I considered my observations of the conditions at the hospital. He broke into my thoughts, “There is no reason an educated person of elevated status should act in such an undignified way. We must always keep our dignity. Once that is lost, it is lost forever.” We walked in silence the rest of the way. When we parted, I said, “Well, I am glad you were with me. God was protecting me.” He nodded in agreement and turned to go his own way. I guess thisis my way of asking for a prayer of wisdom for me as I, no doubt, will deal with this very awkward situation, having lost the trust and respect I once had for a talented doctor. I think he needs help. He needs Jesus. He probably also needs AA (alcoholics anonymous), if only they had that in Ethiopia. Pray for us.

Reflection on Week 1

On being uncomfortable.

I have been trying to process the feelings I had last week when we arrived. I wish I could chalk it up to jetlag, but although a lack of sleep will exacerbate any feeling whether happy or sad or angry or frustrated, I think there was more to it. I have been in other countries among different cultures many times, but this was the first time that I arrived at a destination without an American or westerner meeting me and showing me the ropes for a couple of days. Even though I’ve been to Ethiopia a couple of times, I had never been to this part of the country. The discomfort was surprising to me, and I will say that it wounded my pride of self-sufficiency. I will confess that.

What a difference a week makes! At the hospital, I have made friends with the other students. I know most of the faces in the gyne ward, and they even come looking for me if they have a teaching conference or a procedure. Once, they even took the time to search at the fistula hospital before finding out that I was outside the door to the conference room. This made me feel very included, and I look forward to the next weeks of learning together. Secondly, we have become familiar with the location of our house. We are not near any other ex-pats or westerners as most of them live at the other end of town (about 2-3 miles away), but we are not far from a busy intersection which is lit at night, hotels, and the lake, and we feel fairly safe even walking together after dark for short distances when there are a lot of people around. Third, while walking around, we no longer keep our gaze averted so people don’t bother us. We have found that if we look at them and greet them first, they usually break into a smile and pass us without asking for anything. Usually, if someone starts a conversation next to us, we have found it to be very enjoyable. Fourth, we have met many other ex-pats/westerners, most from Australia actually. We now have a few people to call when we want to play games or go to dinner in the evenings. Lastly, the cooking. Ha.



On cooking in Ethiopia

We have come to really enjoy restaurants here. They range from the most cheap (less than $3 for 2 people to be stuffed) to the most expensive ($10 a person). But, alas, you are looking forward to another story about my cooking. Many of you wrote emails to me to say you would like to come over for my tomato paste pasta- well, I do love to entertain, but I would certainly like to see you have a smile instead of a smirk when you eat at our house. I will practice, and Ryan will need to be the bearer of many smirks before I get it right. Berhanu asked his sister to come over and teach me how to make a proper tomato sauce. I laughed when I saw how much garlic she bought me (about 12 whole clumps!). I tried to explain to her that 1 clump will last me a month at least in the US. Then, I saw her make the tomato sauce.

1 tomato, 1 whole clump (over 10 cloves!) garlic, and 1 onion about the size of the garlic, and oil. It WAS tasty, but good thing we both ate it- otherwise our garlic breath may have driven the other to sleep in the next room. Apparently, Ethiopians put garlic in random dishes. One Australian explained that he had found garlic beneath his custard. Eww. Another told me her mango juice tasted like garlic because they used the same knife to cut the mango. I have become proficient in cooking eggs here. You natural cookers will laugh that it took me a week, but there can be an art to egg-cooking too. It’s not just like the commercials, “This is your brain on drugs,” with a perfectly white fried egg. No! My eggs could be any organ system on drugs… the lung, the liver, etc. For instance, you can fill the kitchen with smoke from the oil if you are washing dishes instead of putting the eggs in on time. You can look like a good tap dancer, albeit with jerking and ungraceful movements of the upper extremities, if you put too much oil in the pan. (It can really splash and hurt when you drop the egg in.) You can get stringy crispy pieces which are about as tasty as shoestrings if you put too little oil in the pan. I have not tried garlic on eggs, but since we have so much…. hmm.



On our weekend

We had a wonderful, restful weekend. Dr. Browning invited us to go birdwatching down by the lake with he and his two young sons. William is 4 years old, and he knows many of the birds including the sounds they make. His 5 month old brother will, no doubt, learn very soon. He can already coo. (Sorry for the corny joke.) San Antonio may have a riverwalk, but Bahir Dar has a lakewalk! It is a nice meandering path paved with cement “tiles” which is about 8 feet wide. Along the waters edge, there were many fig trees and abundant papyrus. Ryan will attest that I was a bit obsessed with the papyrus. Although I couldn’t figure out how they made paper out of it, I could see how they would have been able to hide Moses if, indeed, the reeds mentioned in Exodus were papyrus. We enjoyed our walk with Dr. Browning, especially talking about how he feels about raising his family in a foreign country. We returned to have breakfast with his wife at a hotel which is on the lake. I hope to do this many Saturdays.

Saturday evening, we joined one of the families which Ryan is working with at the church where Compassion International site is located. (Ryan already blogged about them, so this may be redundant.) Trudi and her husband Anthony are Australian and have 3 kids. Their church in Australia did not just adopt a Compassion kid; rather, they adopted a Compassion church! Various members of their church will come to Bahir Dar to volunteer for a few months at a time. It is very inspiring. We went to a “Resort and Spa” for dinner. Imagine that! It was very pricey, and we at first declined their invitation, but we decided that the fellowship would be very sweet, so we shared an appetizer and main course, and Trudi ended up paying for us “poor students.” The resort was like an upscale restaurant in the US, and it was located right on the lake. I suppose you can see this kind of business in the most unlikely places in the world.

Sunday we attended the protestant church which Trudi and Anthony attend. The service was in Amharic, but a bible school teacher was present to translate the main points for us. When the children left for Sunday school, they gathered at the front of the church, and the pastor prayed over them, not only that they would learn and grow in Christ this Sunday, but he also prayed for them as the future of the church. My favorite part of the service was the singing. At one point, the guy who had been translating for us went to get a big drum which he put over his shoulder with a strap. Then, as the congregation was dancing, he joined them in the front, banging on that drum. The kids had come back from childrens church and were jumping up and down in the front. It was very moving, pun intended!

After church, Trudi asked me to look at one the bible student’s eyes. I took a few pictures, hoping to email them to professors in the US for confirmation, but it looked like a benign tumor to me. It had been growing for over 10 years, and he did not even have light perception in that eye. We are hoping to give him enough money to have the “tumor” removed so that his work in evangelism in the remote areas of Ethiopia will not be hindered by an eye infection. I expect I will have many more of these “consults” during my time here.

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.

One Day in Bahir Dar

Each morning, there is a siren which sounds throughout the city, reminding those without clocks or wristwatches that the work day will begin soon. Already, the birds have been announcing the presence of the morning, although instead of cock-a-doodle-doo, it’s a bang, pitter-patter-pitter-patter as various they land ungracefully and walk on our metal roof. Satisfied with our staple breakfast of eggs, bread and honey, bananas, and mango juice, we pack a small daypack with the essentials: toilet paper, hand sanitizer, water, our bibles, money and ID, my white coat and medical review book, and Ryan’s list of contacts. We step outside, walking down the steps and the dirt path to the gate, exchanging a greeting to the faithful night guard. The mornings are refreshingly cool. The sun has not yet chased away a mist which shrouds the landscape, water vapor from the lake mingled with an almost pleasant smoke from cooking fires. Near our compound, a man tends the rich black soil littered with various green plants. Our guard smiles and waves at us from the gate. On the road, we join the steady stream of people walking, biking, and driving toward the city. Near the second roundabout, a large Ethiopian Orthodox Christian church stands. Women with heads covered in white scarves and men stand at various places along the stone wall surrounding it, praying with lips moving, bowing slightly and repeatedly, hands making a cross over their body. On small tarps laid out on the ground, crosses and small religious books and posters of Jesus and Mary and various saints are displayed for sale. Beggars sit at the church gate. It never fails that we will be asked at this corner whether we would like to hire a boat to visit a monastery on the lake- understandable as the city does rely on tourism.

Across the roundabout, the bajaj wait for customers. It’s the Ethiopian version of a rickshaw, a three-wheeled open vehicle which carries 3 passengers. They regularly go from St. George’s Church to the hospital and from the hospital to the open market. To stop anywhere along the route, you simply tap the driver on the shoulder or say, “Bak a.” They weave around bicycles or other bajaj and duck out of the way when a larger vehicle like a car or truck come from behind. At the entrance to the hospital, a large banner reads Felege Hiwot Referal Hospital. As I walk, I pull out my white coat and put it on. Some days I have joined the gynecology ward or the surgical ward for morning rounds, but today I am going to the fistula hospital, which is at the back of the main hospital grounds. We divert our course to the left, avoiding the main patient areas. A gravel road curves around the administration building. Under the shade of a few old and tall trees, plastic chairs and tables are arranged and people dart in and out of a traditional round hut with coffee and tea for those sitting there. Ryan and I part ways here. It is a perfect place for him to wait, read, make phone calls with our borrowed cell phone, or sleep. I continue for a short time on the road which skirts the outside of the hospital buildings. A green sign ahead reads “Bahir Dar Hamlin Fistula Hospital.”

There are benches under the shade of trees, a small garden of flowers,and the main hospital building to the right. On the left, there is a small building for health records and documents and a building in the back for laundry and cooking injera, the local food staple. Several bikes are parked near the entrance to the hospital, likely belonging to Dr. Andrew Browning and some of his staff. I walk in. There is a physical therapy room, a spacious bathroom, one exam room which looks like it doubles as an office, and then a nurses’ station. There is one large area which makes up most of the building, and this is where the patients stay. There is a low wall separating two sides of the room. Pre-op patients are lined up in beds making an aisle on the right, and post-op patients line both sides of the aisle on the left. Along with creating a comfortable family atmosphere for the patients, it must be convenient for the staff. I can imagine a conversation.“How are the patients doing today? Did everyone get something to eat? Is anyone in pain?”

“Let me check,” as she looks up from her desk. “There are 17 pre-op and 25 post-op. Looks like everyone is eating. And, no one is in pain. Anything else?”A frosted glass door is at the far end of the building.

Behind it is the surgical area. Before we begin the day’s work, Dr. Browning gathers the staff. A passage from the bible is read, first in English by Dr. Browning, then in Amharic by the head nurse. Dr. Browning then says a prayer for healing and safety in surgery for the patients and for us as we take care of them. The Ethiopian staff then whisper prayers of their own, often bowing and crossing their hands in front of them as we had seen in front of the Orthodox church.

Rounds begin. A wheeled cart with patient charts neatly filed and daily logs for the nurses is pushed along as we move from patient bed to patient bed. On the post-operative side of the room, most exams consist of mainly checking to see if the bed is dry, the abdomen is soft, and the urine in the catheter is clear. On this day, there is even an infant joining her mother on the hospital bed, which is a joy. Dr. Browning explains that it is very rare to have a live-born child and sustain a fistula. 93% have a stillbirth. On the pre-op side,there is a new classification system for me to learn. Each number or letter describes how far the fistula is from the urethra, how much of the bladder/urethra is involved, and how scarred the tissues are.There are patients waiting for a second stage of their operation if their case was complex, newly-admitted patients, previously-cured fistula patients who are now pregnant and awaiting delivery (which will be at the hospital next door), and finally a young, brave girl less than 9 years old, a victim of trauma.

We finish rounds relatively fast and head through the frosted glass door to the surgical area. We change into scrubs, wearing cloth hats and masks. Everything is reusable, even the gloves. There is no anesthetist, so either the OR nurse or Dr. Browning administer the epidural. There are two operating tables in one room. As Dr. Browning finishes his first case, a second patient is brought in. We step outside and have some tea and bread. The second case is for the Ethiopian surgeon who is here for training for a couple of weeks. Dr.Browning says he would have me do parts of the surgery if there were not any doctors here from various places in Ethiopia or Africa scheduled. “But we are nearly always booked with trainees,” he confides. I am content to be learning by observation from one of the best fistula surgeons in the world. “There are only 4 dedicated fistula surgeons in the whole of Africa outside of Ethiopia,” hestated. “I had 8 job offers last time I was in Nairobi.” Indeed, it appears that his presence in Bahir Dar will not be needed indefinitely. He is training himself out of a job here, which is a great thing for Ethiopia.

The atmosphere in the surgical ward is quite relaxed, yet still efficient. Dr. Browning goes in to watch the next case, tea and bread in his hand. We sit behind the guest surgeon, having our tea break. (For all the non-medical people reading this, food and drink would never even be allowed past the equivalent of the frosted glass door in the US). The third case is a previously-cured fistula patient who went into premature labor. She was unable to get to a hospital to deliverby caesarian, and her fistula re-opened. “This is a difficult case,”says Dr. Browning. “There are 4 principles of fistula repair: mobilize the tissue, protect the ureters, keep the urethra length as long aspossible, and do a dye test to make sure you have adequately sealed the hole in the bladder. Here in Bahir Dar, we’ve added a fifth: finish with a sling using [some of the pelvic floor muscles]. It has dramatically reduced our stress incontinence rate. I wrote it up in a medical journal when we first started using the sling, and the bloke (Dr. Browning is Australian) who designed the mesh that is used in the developed world wrote to me that it would never work. Well, I’ve been using it for 8 years now. Never had a problem.” He turns back to his work. He turns to me again, saying emphatically, “The mesh is $600. If you divide the number of major operations by the number of patients,we spend $250 per patient. I just cannot see adding that expense if the other works so well.”

All 3 surgeries are done before 11:30am. It is quiet in the hospital. Normally he has 6-8 surgeries before lunch. Since they are just at the end of their major holiday season, fewer patients have come to the hospital for treatment. I walk past the patients who are in the physical therapy room, listening intently to an instructor. Ryan is waiting for me under the trees by the café. He has made contact with Jose, a Spanish doctor who is here to make improvements to the government hospital. Ryan has had a chance to discuss the state of Ethiopian health. We begin talking about our day and the things we have learned as we walk down the road to a nearby restaurant for lunch.

The day has turned warm. The sun feels close, but not intrusive. Young children yell out, “Hallo forenje!” and then hide when we look their way. The main road is paved, with wide stone paths nearly the width of a car lane on either side of the road for the majority who are walking. “Where are you going?” we are frequently asked. “Are you fine?” “How do you find Ethiopia? Is it good?” and even, “What do you think about the Ethiopian Airlines. It was just an accident.” They are very proud of their country; at the same time, they would likely jump at the chance to come to America. We heard the statistic that there are more Ethiopian doctors in America than in Ethiopia. Sad.

We arrive at our new favorite place to eat. SubAfrica. There is the same Asian gentleman that I have seen every day at lunch. Soon after our food is ready, a Swedish couple I have seen every day comes again. We talk to the owner again. The talk turns to religion. “So you are a Christian. Now the question, what kind?” I say, “We follow Christ, we follow the bible. That’s what we look for in a church.” He pulls up a seat, “Good, I read a chapter every day. You should too. It will change your life.” We discuss what we have read, Ryan mentions that he is reading through the bible in one year again and how that has impacted him in the past. We discuss the end times. It is stimulating conversation. This American-born hippie running a random sub shop in Africa who has lived all over the world and is very anti-government is also very versed and passionate about the Bible. I suspect we will have many more conversations.

Ryan walks with me back to the hospital. He leaves for the church where he will be running a soccer practice. (Bug him to blog about it!) I return to the government hospital to the gynecology department. There are at least 7 patients lying on mattresses in the hallway. Now this happens from time to time in America, especially in the emergency room or in ob triage in America. But this seemed a permanent solution to space problems. On the wall above the mattresses, there are numbers written on the wall and nails where a few IV bags are hanging. One patient looks like she is in serious condition. Her father squats next to her, holding her head. As I stand there, the doctor approaches me.“What is the management for a patient with ecclampsia?” Oh, that’s what she has. “Deliver the baby. Right away,” I say. “Correct. That is what we have to do. She is being induced right now. Previously, they had her in the medicine department because they thought she had cerebral malaria. Instead, she was seizing from ecclampsia.” Wow, cerebral malaria wouldn’t even be thought of as a possibility at home!Another woman in the hallway is moaning. The floor is wet like water has been spilled. A student whispers to me, “Her bag of waters is broken. She does not want the baby. Now she will go to the obstetrics ward.” How is she going to get there in this condition?

In the gynecology office where Ryan and I first came when we were at the hospital, we sit to wait for a procedure. The students ask for my medical review book. Each night, a different student will ask to take it home for the night so they can prepare for a presentation. They are so eager for books. I decide to borrow their main book of ob/gynlecture notes. It looks similar in content, except with more emphasis on physical examination than on laboratory and radiological tests. Soon, the doctor comes in and motions for us to come. They are doing an ultrasound. We walk in a dimly-lit room which is the width of a bed. There is a woman on the bed. An ultrasound machine is turned on. We crouch around the screen. Surprisingly, it has a fairly good quality picture, but the screen is about half the size of the computer screen I am typing on. It does the job. We measure the BPD (biparietaldiameter, which is a fancy way of saying we measure how big the head is) to see if we can determine how far along the pregnancy is. According to their medical lecture notes, antenatal (before birth)pregnancy care is only used by 28% of the population, so most patients will not have any previous way to know how many weeks they have until they deliver. Maternal mortality rate in Africa is 650/100,000, East Africa is 680/100,000, and Ethiopia is 871/100,000. With a fertility rate of 5.7 children, these women have a 1 in 21 chance of dying as aresult of pregnancy and childbirth.

I catch the bajaj to the market, and walk to Berhanu’s office where Ryan is waiting. He looks sun-kissed and so do his shoes. The dirt has a red tinge here. He explains how he conducted soccer practice without using words. “At least when I coached the LeTourneau girls, they knew what I wanted them to do even if they didn’t always do it.” He smiles.“I had to take a kid and stand in one place, act like I was playing defense, and take another kid and stand there and act like I was playing offense. I thought they understood, but then the offender kicked it straight to the defender. I gotta learn Amharic.” There is free coffee here, and Berhanu allows us to use his internet when the power is working. He gives us suggestions on where to eat tonight. We walk down to a restaurant that serves pizza. It is not American pizza, but it is good. We walk home. There is time to play Carcassonne, read, prepare for the next day, and type our emails so that we can copy and paste at the internet cafés.