Gimbie Reports

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.

As I have related in previous posts, Friday is often the busiest day of the week. Last Friday night I was congratulating myself on a relatively peaceful day.

The earlier part of the week had been rough. Government inspection, a fight in the laundry, an intense four hour general staff meeting. The hospital is full, the community is satisfied with the care we give, and we are marginally in the black, but there is no way that salaries can keep up with the spiraling cost of living. It is hard for staff to be happy when they are hungry.

For the sake of the censors who will read this post before you do, I will indulge in a short story that of course has nothing to do with the hospital. Once upon a time there was a bakery. It was the only bakery in town and everyone came there to buy bread. The bread was good, and the people were happy. Then new bakeries came to town. At least they were called bakeries. But they didn’t bake much bread. And what they did bake tasted bad. So the people kept coming to the old bakery, which still baked good bread. But the bakers at the new “bakeries” got paid lots of money—money that came from other towns, not money that came from the sale of bread. These bakers were happy because they did not have to work much since nobody really wanted their bread. But the bakers at the old bakery were sad. They knew that they were better bakers than the bakers at the new bakeries. They knew that their bread tasted better. They knew that the people love their bread best. And they were always busy baking bread, sometimes all night long. The trouble was that they did not get paid as much as the bakers at the new bakeries, because the old bakery only got money from selling bread. The manager of the bakery was always thinking of ways to make the bakers feel special, but it was hard because he didn’t have much to work with.

Anyway, last Friday night I was baking pizza with Petra, Renee, and Becky. It was Becky’s birthday. Some kind soul mailed us a jar of green olives stuffed with garlic. These were the centerpiece of a fine smelling pizza that was about ready to come out of the oven. We had just opened the Sabbath.

Then someone pounded on the front door. A young girl seemed to have acute appendicitis. Our surgeon was in Addis getting his license renewed. Our GPs and ob/gyn refused to operate—with good reason. Anyone who operates without a license for surgery gets a free stay behind bars.

A couple years back the great Erling J Oksenholt in cooperation with Bob Barden facilitated the donation of a Ford ambulance to Gimbie Adventist Hospital. Most of the roads around Gimbie are too rough for the ambulance and few patients have the money to cover the cost of fuel for its thirsty V-8, but there are times when the ambulance is simply invaluable. Friday night was one of those times.

I ran out my front door, grabbed the keys from Mark (who was overseeing an evangelistic campaign in the hospital auditorium) put the girl and her family in the back of the ambulance, got Ellen (a visiting EMT) and Beniam to ride shotgun, said a prayer for safety and tore off into the night.

The lights and siren parted the crowds of Gimbie like Moses rod and the red sea. The guards at the Gimbie checkpoint respectfully raised the barrier and we were on our way to the government hospital in Nekempte.

Most of my driving time in Ethiopia has been behind the wheel of the hospital’s land cruiser. The land cruiser has many admirable qualities, most of them only apparent off road, but it is not particularly powerful, corners poorly, and becomes highly unstable above 60 mph.

The ambulance may be ill suited to rough roads, but it is very stable, and at least in comparison with the land cruiser, it goes like a bullet out of a gun. I know my mom and Bob Barden will read this, so I won’t say exactly how fast I drove or how long it took us to reach Nekempte. Suffice it to say that little time was wasted.

About 40k from Nekempte it started raining hard. It felt like a hundred fire hoses were aimed at the ambulance. I had to keep the window down to keep the windshield clear. I was soaked in seconds. The rain stopped quickly and steam rose in clouds from the warm asphalt. This made it tough to see the road surface.

The road between Gimbie and Nekempte crosses a number of rivers and creeks. At one of the smaller bridges a foot of water was flowing over the road. We plowed right in at a decent clip. Ellen screamed. I kept the wheel straight and avoided the gas and break. Water shot onto the windshield and over the top of the ambulance. A few tense seconds later we were on the other side.

The end of the trip was anticlimactic. We pulled into the Nekempte hospital, had the girl out of the ambulance on the stretcher almost before the ambulance stopped moving, and then waited for the surgeon to show up. And waited for the surgeon to show up, and, well, you get the picture. We left before the surgeon arrived. The girl’s father is a well connected dude. If there was a surgeon in within cell phone range of Nekempte that night, he was called in.

The drive back to Gimbie was peaceful. The people in the roadside villages had gone to bed. We saw several hyena, Ethiopian deer, some dik dik, mongoose, and a beautiful owl. Ellen and Beniam dozed and I thought about the story of the bakery.

Even if times are tough at the old bakery, at least the bakers and their manager can take comfort in the quality of their bread and the quantity of bread that they provide to the community. I don’t know the end of the story. Part of that may be up to you. But I do hope that someday soon when the Master Chef will call us skyward, the poor workers at the old bakery will get a special reward.

At 11 pm last night I was sitting in a guest room at the Union offices in Addis staring at the screen of Renee's computer. All I had to do was switch the hospital's new five year plan from word to pdf and submit it on CD to the respective offices this morning.

Which doesn't sound like a big deal, but the whole process was balanced on a knife blade and if I didn't get the plan switched to pdf there would be trouble for sure, because some personages who view the hospital's activities with a jaundiced eye are on annual vacation--for now. Odd as it may seem unless the document was in pdf on the appropriate desk in the morning, the hospital would have no five year plan, no right to operate, no right to import supplies, and little chance for future survival. TIA.

I'm reasonably computer savvy, but I haven't gotten a full nights sleep in ages and the obvious quickly became opaque.

The internet at the Union is abominably slow, but I started loaded facebook while I was fiddling with the plan and five minutes later the page came up and a girl hailed me via facebook chat. I didn't know her. Most of our staff add their friends, so that wasn't surprising.

I was in no mood to chat and fired off a few terse words in reply. Facebook is distracting and I almost signed off. Then inspiration struck. I told the girl what I was struggling with, which wasn't easy because most days I could just about do the pdf switch in my sleep, or so I thought.

She happened to be in the library at Southern Adventist University. She enlisted a librarian (blessed be all libararians) and started giving me instructions. Lo and behold, the plan was in an antique version of word. A quick switch to word 07 and the process was complete.

I know this story sounds trivial, and compared to our surgeon crisis, supply shortages, and the odd death threat it is. But to me it was a miracle, just in time to save my faith and sanity.

So thank you God, and Monica Nunez, thank you. In your own small way you saved the hospital.

Last night two guys named Abdissa and Benti came into the ER with multiple stab wounds. Abdissa had been speared in the head, like the spear actually went in, not some glancing blow. We were still surgeon less and in any case we don't have the capacity to handle massive skull fractures of this kind.

Priscila did her best, but it was pretty clear that Abdissa would die in Gimbie and would have some chance in Addis. Given the gravity of the situation, I decided Abdissa was worth part of our charity budget. I went to his family and told them we were willing to transport him to Addis for free.

They didn't seem excited or thankful, which was weird because patients and their families typically erupt in tearful "God Bless yous" at this point. Between my bad oromoiffa and their bad English, it was tough to figure out what the catch was. So I called Birassa, the hospital's purchaser and billing officer to translate.

The family had no interest in treating Abdissa. They came to the hospital for a court letter (MD's analysis of the cause of death) which they are planning to use to sue the pants off the spear thrower, who is a well heeled local gentlemen. Abdissa's family actually hoped that Abdissa would die quickly (they figured he would die in ER last night) so they would have an easier time in court.

Patient rights (i.e. family rights) are the name of the game in Ethiopia and we couldn't force Abdissa to stay. Birassa and I gave it our best shot. If Susan Smith's jury had heard passionate and well reasoned appeals of our caliber she would have walked with 10 days of community service. Abdissa's family did not bat an eyelid. They picked Abdissa up (incredibly, he was still alive and conscious) and took him home to die.

I don't think Priscila or I will sleep well tonight. Which is a great pity because she will be on call tomorrow and tomorrow night and I have to drive to Mugi starting early and goodness knows neither of us have been getting anything like enough sleep.

Usually we have trouble with people asking for charity when they have money to pay. It is rare indeed for free treatment to be refused. It hurts. I wonder if this is how Jesus feels when we thumb our noses at his offer of eternal life because we want revenge. How utterly stupid and cruel of us.