Gimbie Reports

Teshaynesh is a long time hospital employee. For the past five years she has served as cashier for our clinic in Nekempte. During this time, Teshaynesh put herself through nursing school.

At the same time, the hospital was sponsoring her husband Yoseph to get his diploma as a lab tech. When Yoseph finished, the hospital moved him to Gimbie to work in the main hospital lab. For several difficult months, Yoseph and Teshaynesh were separated. To further complicate matters, Teshaynesh became pregnant.

Sometime during her maternity leave, Teshaynesh graduated with a diploma and received her license from the government. We moved her to Gimbie so husband and wife could be together. There was a vacancy in the male ward, so it looked like long suffering Teshaynesh would finally have her dream job.

Except for one thing. She turned out to be a terrible nurse. Teshaynesh flunked our standard entrance exam, so we had her work as an assistant in the wards, hoping that a month or two of practice could improve her knowledge and skills.

But it didn’t. She mixed up the drugs and managed to nearly send a very important someone “into a far country.” Last night I gave her an exam. It was the exam Becky used to screen second year nursing students who wanted to join our school (FYI, our school is now widely recognized as the best around. The government inspectors were so confident of our compliance that they didn’t even bother to visit—good job Teshome and Becky!).

The exam should have been a piece of cake for Teshaynesh—she had had three times as much schooling as the intended test takers. But she totally bombed. She said that the digestive system pumped blood through the body, 62 beats per minute was an abnormal heart rate, and the pituitary gland was part of the skeletal system. Teshaynesh’s English is poor, but that can’t explain how Tejube, who had only one year of school and no English, performed far better on the exam.

Of course Teshaynesh was in a difficult place. She had her diploma and license, she knew that the hospital needed a nurse, and she wanted the job with all her heart.
Ethiopia being Ethiopia, all the nurses were publically supporting Teshaynesh and kicking up a royal reek about her working as an assistant—then coming and talking to me privately and begging me not to schedule Teshaynesh on their shift.

I discussed the situation with Engedi, one of the better nurses at the hospital and the head of ER. We recognized that Teshaynesh’s situation was a big deal to her and the other staff. We both saw both sides—if Teshaynesh was hired, patient care would suffer, the other nurses would be overworked, and the chances of full scale disaster were moderate to high. On the other hand, if Teshaynesh was not hired, she and the staff would give me no end of grief, large scale insubordination was likely, and I would stand a decent risk of physical harm.

Engedi’s final statement was classic: “Oh Mister Paul, it is too hard to be the administrator of a hospital in Ethiopia!” “I know…” I said, and put Teshaynesh on the schedule as an assistant…

Steller Staffer: Adise

There are many stellar staff member here at Gimbie Adventist Hospital; some excel professionally and others shine personally. One of our nurses, Adise, exemplifies family commitment and financial generosity. Adise and her husband, Abera, are in their 30s and have two young children. They work hard to provide just the basics (food and clothes) for their small family. Recently this task has increased in difficulty.

Five years ago Adise’s sister, Sara, passed away leaving behind her husband, Abebe, and two young boys, Amuel and Yaqiob. Abebe then became the sole provider for his boys ages 7 and 4. However, Abebe is HIV positive and over the past five years Abebe’s health has deteriorated. Simultaneously, his dependency on Adise and Abera has escalated. Because of the HIV virus, Abebe is unable to do manual labor. Instead he tailors clothes by hand to earn some money. Even so, Adise knows if she does not give them leftover food or buy them grain they will starve.

Today, Amuel and Yaqiob, ages 12 and 9 respectively, attend the tuition free government school although they would like to attend Adventist school with their friends from church. Their after school responsibilities include caring for their father, helping with household chores, buying and carrying water from the pump in town to drink, cook, and wash with, and lugging home charcoal to make a fire for cooking.

Adise tries hard to fill the absent mom role in the boy’s lives. Despite the challenges in her own life, she still gives her time, emotions, and money to her extended family in need. Adise is happy that regardless of the hardships Amuel and Yaquiob have faced they are growing up to be smart, Christian youth.

Gimbie Adventist Hospital is one of the largest employers in the town of Gimbie. There are about 230 full time staff and 100 daily laborers. We are proud that many of our staff, even the lowest on pay scale, give their own money and food to community members in need. It is impressive because Adise and other staff do not give from their surplus. (There is no surplus to give from!) They give straight from their pocket or dinner tables via their heart. May Adise and other selfless staff be abundantly blessed.

Last night I was with Becky and Priscila indulging in some escapism courtesy of Jackie Chan and Owen Wilson when I decided that our experience would be enhanced by speakers.
I was on running back to Becky’s place, speakers in hand, when I literally ran into a small mob.

Several of our more hot tempered guards, a garden worker, and a number of ex hospital employees were rather quietly sneaking towards my house. I’ve had a number of death threats recently, mostly because I helped end a stealing streak at the nursing school construction site. I haven’t paid much attention because a number of past promises to machine gun me have apparently fallen through, our employees are mostly very loyal, and staff moral is high. But when I bumped into the group last night I did wonder...

After exchanging a few tense greetings I discovered that they were coming for the brother of a hospital employee, who happens to live under my house. The guy, who we shall call Benti, has a history of psychiatric problems. He is also rather brilliant and is currently enrolled in a bachelors of nursing program in Awassa, sponsored by the hospital. Benti’s girl friend recently dumped him and he chased her across the country. No one was sure if he was hoping for reconciliation or revenge, but given his history, the girl made herself scarce and Benti drifted back to Gimbie without meeting up with her. I’d talked to Benti about some of this that afternoon and learned that he was heading back to school in the morning. Like many people in his condition, Benti had no interest in drugs or treatment.

It soon became clear that the group’s intent was to tie Benti down and shoot him up with some bootleg high powered psychiatric drug.

I have a fairly long fuse, but I was not amused by what was going on and said so in no uncertain terms. For one thing, if Benti really was dangerous, all of them stood a decent chance of getting cut up in their sleep when the drug wore off a few months down the line. More likely, he would go to the cops, convincingly plead his sanity (which has never been medically challenged) and get the group locked up for assault and unlicensed use of dangerous drugs. In addition, Benti was headed to school in the morning and there would be no way to monitor the impact of the injection. Most importantly, Benti isn’t a particularly violent dude and the likelihood of trouble seemed slim. It is hard to rule things out, particularly with the potentially crazy, but given my past experience with the group at hand, I’d wager a considerable sum that the would be injectors were fair more likely to commit violent crime than Benti, particularly since that is exactly what they had in mind.

After some discussion, things calmed down, everyone went home, and I got to Becky’s in time for the out takes. Never a dull moment.

Recently the sunshine has dominated the sky and dark hefty rain clouds have submitted to the resilient rays’ command. Despite the decrease in rain and the increase in sunshine, mornings are still chilly. It was unusually cold this morning when my alarm sounded. Knowing Becky would be getting up too, I sluggishly threw the warm bed coverings off: two thick wool blankets sandwiched between a cotton sheet and a thin maroon throw I purchased at a local Muslim shop.

Becky and I groggily met in the living/dining room. “What are we doing?” I asked. “Beach Body?” she suggested, referring to her exercise DVD. I utter an “um-K” as I returned to my room to grab my mat. Within moments we were led by our “friends” Tony, Pete, and Lisa through stretches, power Pilates, and cardio. “The cardio section’s not long enough” Becky stated. So we went outside to run the red dirt steps between our house and the hospital.

Yesterday we did not exercise or shower; for us the two go together like a pen and paper. Even though today is colder than yesterday we MUST shower. Thus we push ourselves to raise our heart rate and sweat. Our morning motivations are mutual: because the shower is cold we exercise and because of the warming exercises we shower.

Becky Carlton, the dean of Gimbie Adventist College of Health Science, is an alumnus of Pacific Union College. In PUC’s quarterly Alumni Magazine, six pages of Becky’s adventures are featured.

To read about her experiences and see pictures from Sudan and Ethiopia go to http://www.puc.edu/campus-services/public-relations/pr-projects/viewpoint and select the “Fall 2009” issue. The cover is blue with two Ethiopian children sitting on a bench.

The stories of our patients that receive charity are often similar; they have no education, no work, and lack health. Today, we discharged a Save-A-Life patient with a somewhat different story.

About 10 years ago Bekuma served the Ethiopian Army as a soldier. While fighting on the boarder of Eritrea he received a bullet wound to his abdomen. He had abdominal surgery at a border-land hospital and was sent home to Gimbie. After he recovered, Bekuma found work on a day to day basis. His wife Alemtsehay also worked as a daily laborer but stopped when she became pregnant with their first child.

Since then, Bekuma has felt the continuous responsibility of feeding his wife and three daughters. Often, Alemtsehay will leave the girls with a neighbor to find miscellaneous work for more desperately needed money.

Despite their poverty, symptoms of severe abdominal pain, vomiting blood and fever, motivated Bekuma to come to Gimbie Adventist Hospital . He was seen by Dr. Priscila, our general practitioner, and referred to Dr. Khalid, our surgeon after it was found that his previous wound had herniated. Dr. Khalid performed an emergency hernia repair.

Bekuma is grateful for the treatment he received at Gimbie Adventist Hospital. He acknowledges that it is God’s providence that allowed him to receive medical treatment. Gimbie Adventist Hospital is thankful that God has blessed the hospital with generous friends and family.

I watched the baby breathe. 1, 2, 3… 17 breaths. 3 second pause. 7 breaths. Pause. With a mighty sigh, she started breathing again. Her nostrils flared despite the teeny nasal canula in her nose. Her accessory muscles heaved out the breaths her ordinary muscles had grown tired of supporting. Her perfectly formed fingers were limp, pale, cold. There was a cyanotic ring around her mouth.

In utero, she had been in distress for hours. Her mother hadn’t wanted to have a C-section, despite the information that her baby’s head was too big for her pelvis. Finally with the doctor screaming at the mother-to-be, her fingerprint was pressed Into the paper, sealing her alleged consent. It took around a half hour to get the consent, and another half hour to secure proper anesthesia for the surgery.

My shift was complete, but I didn’t want to leave. I wanted to make sure the baby breathed. There was a miniature ambu-bag at the foot of the bed in case she stopped. Not that it would matter. Even if we do CPR, there is no way to correct the causative physiological factor(s). So the patient usually dies anyway. I touched her small chest, counted her heart beat and felt her lungs expand. I held her small cold hands to warm them and checked to see if perhaps she had any reflexes. She didn’t.

Finally, she moved her tiny limbs. The machine continued to pump oxygen into her starved lungs. She breathed. Her heart beat. So I went home to get some rest. In the morning, she was gone.

This past Friday was Ethiopian New Year. I awoke in the gray shadows of the morning to rambunctious chanting outside our window. The children of our hospital staff were carrying out the yearly tradition of yelling for lemons. The steps of the ceremony are basically as follows: 1. Kids gather outside your front door and chant, “In Qutattash!” (It’s New Years!) in exuberant expectation. 2. You sleepily drag yourself from under the covers, and go open the door. 3. If you have any lemons, you give them each two. If you don’t have any lemons, you have to give them a birr. 4. They go away. Thankfully, we had just enough lemons to pacify our visitors.

At breakfast, we wished each other a “Happy 2002!” Ethiopians follow the Julian calendar, which is 7 ½ years behind our Western Gregorian calendar. A local story explains the disconnect. Apparently, the world leaders gathered and decided upon creating a new calendar. The Ethiopians thought it was a wonderful idea, and sent an emissary to collect the new design. Unfortunately, what with the difficult road and the distractions along the way, it took him 7 ½ years to arrive back with the calendar. Yet, in typical enthusiasm, the Ethiopians decided to begin following the calendar right away.

No one works on New Years. We spent a delightful day lazing around the house, trying to be as unproductive as possible. The medical staff had a relaxing day as well… at least until later when the post-holiday trauma began to filter in to the ER - mostly those who had over-eaten or been injured in drunken brawls. We ordered tea and cakes for all of the hospital staff who had to work, and good cheer was preserved.

The next day was Sabbath – the first time I have ever enjoyed two consecutive “days off” at the hospital. I joined in the mass choir which performed for the celebration at church. We belted out multiple local songs, all in Oroomiffa and all in unison. The rafters were strung with twirled toilet paper (to resemble streamers), a few strands of plastic flower chains bedecked the sanctuary, and the pulpit emitted an electrifying strobe of red Christmas lights, which kept the congregation mesmerized throughout the service. Smiles radiated from every face. A New Year meant new chances to do good.

On Sunday we were back to work at the hospital. Still, it seemed like a new exuberance pervaded the building. We were so inspired that we couldn’t help but make New Years’ resolutions together over lunch. I intend to have better posture. Renee plans to wake up earlier. Paul resolves to exercise more often. We’ll do our best to keep these promises… but then again, if we slack off, the rest of the world’s New Years is only 3 ½ months away…

According to Strunk and White, authors of The Elements of Style, a participle is “a verbal that functions as an adjective” (93).

Yes, a verbal. I had to look it up too.

A verbal is “a verb form that functions in a sentence as a noun, an adjective, or an adverb rather than as a principal verb” (95). Basically, a verb went to a costume party and we call it a participle.

The challenge was to teach identification and usage of participles to 23 EFL (English as a Foreign Language) students that still mix up past tense and do not understand commands. (Disclaimer: There are about 6 other above average students that are capable of understanding and using participles.) Our nursing school students will be tested over this information when they take the governmental exam upon graduation. Therefore, they must learn and I must teach.

Following the advice of Frauline Maria per Rogers and Hammerstein we started at the very beginning: verbs, nouns, pronouns, adjectives, adverbs, and subjects. Then, we progressed to present and past participles. All students were copying the example sentences and taking notes. Next, participle phrases: modifiers, objects, and compliments. Somewhat confusing, but punctuation rules make identification of these phrases rather simple.

After one hour and thirty minutes of definitions, diagramming sentences, and learning the rules and exceptions, I’m pretty sure their heads were spinning. I assigned 5 sentences for homework, asking them to underline the participle or the participle phrase, label it as past or present, and place commas where needed.

I am curious to see how they do. Even more, I want to know how I did teaching these undercover verbs. Monday is our next class. I’ll know then.

I drafted several posts for the hospital blog during my second visit to Gimbie but was unable to determine an appropriate topic. My work in the business office (creating a fixed price agreement for procedures funded by Maternity Worldwide and preparing for the current-year audit, both of which were facilitated by Joel Kurtz’s work earlier this year) provided great opportunities for the organization, but I realized that 1) opportunities occur at the hands of all of the hospital’s staff and volunteers, and though many of them are smaller than those I presented, they undoubtedly commit themselves to equal or greater faith and courage; and 2) accounting is boring.

Alternative topics presented themselves from time to time—at the terminus of a long hike, I inadvertently dropped a notepad, which was retrieved by local corn farmers (bearing wood hatchets), who pursued me at full sprint for many miles in attempt to return it—but seemed largely inappropriate for the blog’s historical audience.

As I am scheduling two return trips to Gimbie (a one-month visit in October and again in April 2010), I thought it most appropriate to document how Gimbie continues to change my personal life. This started with a spreadsheet, but given the limitations of this host, I edited it as true type, wherein the first number of each line was an average before my first trip to Gimbie, and the second is a current average.

Diet:
Daily servings of dairy and meat: 3, 0
Daily servings of caffeine: 4, 0
Estimated daily kilocalorie consumption: 2300, 1800

This isn’t a guarantee that individuals who visit Gimbie will develop proper eating and habits, but after developing an appreciation for simple food prepared well, it is exceedingly difficult to reacclimate oneself to complicated food prepared poorly.

Exercise:
Miles ran per week: 1, 10
Miles hiked per week: 0, 12
Hours of group sports played: 2, 8

This isn’t a guarantee that visitors will develop proper exercise habits, either, but after appreciating friends while engaging in hiking or playing volleyball at Gimbie, it is difficult to schedule a social engagement at a movie theater wherein the selected showing is based on a mutual decision of “least likely to make viewers exit the theater prior to ending credits.”

Weight (pounds): 190, <155

Exercising is a terrible method of losing weight: per Richard Muller, PhD, it is possible to burn a pound of fat by 1) running 60 miles; 2) ascending 2,500 flights of stairs; and 3) swimming 25 miles. It is also possible to burn a pound of fat in one week by lowering your kilocaloric intake to 1,600 calories. The food in Ethiopia is wonderful (and it is easy to prepare Western-style food if one is not a fan of local delicacies), but absenting oneself from vices (liquid calories and ice cream) almost guarantees weight loss.

Good Habits:
Weekly hours of reading international news and related research: 0, 4
Weekly hours of pursuing new relationships: 1, 10
Weekly hours of contributing to charitable projects: 0, 20

Proper charity is addicting, and as I have indulged more recently, I have gained increasing disaffection for teachers and professors who have made improper charity mandatory. Proper charity requires that: 1) you are wholeheartedly committed to the individuals or community that you are serving; 2) that you express unyielding affection for all individuals who are also dedicating their time, simply because their commitment outweighs any personal differences you may have; and 3) that you are able to observe positive changes because of your work. I am grateful that all three, and many more, are readily available at Gimbie.