Gimbie Reports

I’ve been sitting for the last 2 hours on a restaurant patio in Dembi Dollo chewing on a toothpick and watching a pregnant goat waddle up and down the street. Maybe she’ll go into labor before we leave.

Ashebir and I have spent the last three days waiting—either for buses or in buses. Tuesday we spent 12 hours traveling 200 kilometers from Gimbie to Dembi Dollo. That included 2 breakdowns, but still, it’s an average of 10 miles an hour! Periods of waiting and the contemplation they facilitate are good for the soul, but I still feel like we’ve wasted a lot of time.

The trip has been a success, though, because of the 3 hours we spent in Mugi conducting a surprise inspection and visiting rival clinics. The rivals turned out to be former Gimbie employees who had felt alienated by my predecessor and quit. One burst into a big smile when he saw Ashebir and me. “You remembered me!” he gushed. By “you” he was referring to the hospital. He wants to work for us again. If you can’t beat them, join them, right? Next week we’re visiting Mugi again (with the Land Cruiser), and hopefully we can seal the deal. Judging from the look of his waiting room, I think he would bring our clinic back to life.

But just as the successful visit to Mugi has been hedged in by bus trauma, so will the content of this article be. Before I close, I have some things to say about the Ethiopian transportation system.

Point #1: There is no system. There are just a bunch of guys with decrepit vehicles who go where they choose when they choose. There are officials at the bus stations who selectively enforce maximum occupancy regulations, but that’s it. Only for long trips can you reserve a ticket, and even then it’s just a reservation with the driver. This morning when we went to the bus station we found there were no buses to Gimbie today. That’s why we’re still here.

Point #2: While the government isn’t involved where it should be (i.e. building bus stations and organizing schedules), it is involved where it shouldn’t be: regulating prices. It sets low price ceilings, and this causes a whole slough of problems. 1.) It creates a shortage of available transportation since the business isn’t very profitable. 2.) It creates a disincentive for drivers to maintain their vehicles since seats in brand-new vehicles would cost the same as seats in dilapidated ones. Even if drivers did want to maintain their vehicles, I doubt their narrow profit margin would allow them to do so. 3.) It leads to overcrowding. Drivers have to pack their vehicles full in order to cover expenses and have something left over.

I do have one good thing to say on the subject: The open-air bus terminals are very nice. This morning as Ashebir and I were darting here and there amid the chaos of shouting people, blinding headlights, and rumbling, exhaust-spewing engines, it was nice to look up and see stars. It shook everything back into perspective. Reality is much bigger than our frustrations.

Epilogue: Ashebir found a flatbed truck willing to take us to Gimbie. We left around 4:15 PM and arrived at Gimbie at 10:30 PM. Home, sweet home.

I’m sitting in a large conference room on the 7th floor of the Damu hotel in Addis. I planned to be in Gimbie right now meeting with the staff but I received a last minute request to present at a national HIV/AIDS conference and now I’m sitting with Dr. Wondwasson and Tsegaynesh craning my neck to see the introductory powerpoint.

Vast amounts of USD come to Ethiopia through the PEPFARS program, much of which is spent on trucks, builds, and trainings rather than patients. Not that I’m complaining about getting an all expense paid trip to Addis, but the net impact of the program on Gimbie Adventist Hospital is hard to get excited about.

The program provides free drugs and training and hospitals are required to provide free staff and free treatment space. Treatment is free. There is no doubt that the program is very good for the patients and I am happy about that. It is a shame that a byproduct is that mission hospitals are financially drained. Just a few moments ago the CEO of Aria hospital told the group that Aria may close soon due to the pressure.

International financial meltdown may have hurt Wall Street’s pride, but here in Ethiopia it cuts into flesh and bone. This is a bad year for the people of Gimbie town. They survive on money from coffee sales and this year there was no coffee. Rains during harvest damages most of the other cash crops. The hospital did not have enough money to raise salaries this year and I intended to freeze them despite the 60% inflation, but some of the staff were literally going hungry and I felt that it was immoral to stand by and let them starve.

The road from Gimbie to Addis is better than it was, but it is still rough. Yesterday I drove in carefully because the welds on the land cruiser’s body are breaking and the whole vehicle is now flexible enough that I am afraid the windows will break. I wish we had the money to fix the welds. I also wish we had another vehicle so that we could give the land cruiser a break for long enough to complete repairs.

We stopped in Bako for lunch and were surprised to meet a group of MDs from Norway, one of whom is the head of Anesthesia at the new CURE hospital in Addis. Hopefully by the time I finish this note she will be in Gimbie teaching our staff to use the Glostavant anesthesia machine that no one in Ethiopia seems to know how to operate.

I was up until 2:00 a.m. last night preparing for this conference and we still didn’t finish. Wondwasson and Tsegaynesh are working on it some more while they listen to the introduction. I should probably work with them or I will be caught flat footed in our presentation.

Chau

Paul

It’s no secret that the clinics have been struggling financially. For a long time they were heavily subsidized by the hospital. Recently they’ve begun breaking even, and I’ve received some donations for facility improvements. This month, they’re doing even better, and it’s mostly because of a visit from Dr. Erling Oksenholt and his team.

Dr. Oksenholt is a legend in Gimbie, and ever since we learned he would be visiting, we had been anxious to him. He arrived on February 10 with a team of 13, and I think he lived up to his name. He brought a wealth of knowledge about the history of the hospital and the field and was full of sagacious advice for us. He also lived up to his reputation for drawing crowds. Literally hundreds of people brought him petitions for school sponsorship, and hundreds of orphans pressed around his house asking for help.

Dr. Oksenholt brought with him a very diverse team. Most were not Adventist, and most did not know each other before the trip. Only a couple had ever been to Ethiopia before. You wouldn’t have guessed it from watching them work, though. They were like a well-oiled machine. And their work was largely for the benefit of the outer clinics.

The team’s internist, ophthalmologist, and dentist dedicated 5 days to the outer clinics and saw nearly 1,000 patients. The doctors were so dedicated that they often worked until after dark to see everyone. The non-medical staff were dynamic, too. They distributed peanut-butter-like supplements for malnourished children called “Plumpy Nut” and administered vitamin A. When they finished, they played counting games with the children and danced the Hokey Pokey.

In the 5 days, we grossed about $2,000, which will allow us to fully stock our pharmacy this month and maybe next month, too, especially with the medicines they brought from the US! The hospital is in such dire financial straits that this week Paul actually asked me if the clinics could make a loan to the hospital. What a switch! I paused to revel in the moment before responding in the affirmative. Actually, I’m still reveling in the moment, and I probably will be for a long time.

Really the best part of the trips was the high-quality care we were able to provide. The patients were extremely satisfied. Lots of painful teeth were extracted, lots of infected eyes were treated, lots of eyeglasses were sold, and lots and lots of sick patients were treated.

Thanks, Oksenholt team! We miss you and hope you all return to Gimbie soon!

She was dying. I’ve been here long enough to know how to recognize it now. Her breath was labored, her skin was pallid, and her pupils did not even dilate when something was waved in front of them. The family – rather extensive - hovered nearby. I bit my lip. My usual procedure when visiting near-death patients is to pray with the family, read some Bible verses about the resurrection (1 Thessalonians 4:16-17 for example), and pass out a few Gideon New Testaments to the family members. But this case was different. I could tell by the women’s silken dresses and the men’s red-checkered turbans that this family was Muslim. How would they react to my advances? I decided it was worth a try anyway. Cautiously, politely, I approached the man who was indicated as the husband. “Excuse, would you mind if we prayed together for your wife?” I asked in Oroomiffa. He scrutinized me coldly, a hopeless, empty expression in his eyes. “Sure, why not?” He said. I bowed my head and began, “Our Father…” The family quieted down and watched me intently. When I had finished, I opened my Bible and carefully picked some verses. Everyone listened respectfully. Before leaving, I passed out some tracts and offered the husband a New Testament. He refused. Later that evening, I heard that Dr. Johnson and Scott Barlow were waiting for her to die in the ICU. I knew she wouldn’t make it through the night.

Early the next morning, I walked into the ward to have a prayer with the nurses, as I usually do. “Have you seen her?!” They asked excitedly. “Seen who?” I responded ignorantly. “The woman from ICU! Just go and look!” I went and poked my head into the unit. There she was. No breathing machine. No pallid skin color. She looked completely normal! “Naaga bultaani!” I greeted her eagerly. She turned and looked up at me with joyful eyes and a massive smile on her face. Her husband hastily stood up and shook my hand emphatically. The other family members grinned and waved. “Would you like to have another prayer together?” I asked. “Yes, yes, yes!!” They all chorused at once, “Please pray for us!” “Let us thank God for this great miracle.” I said. “Amen, amen!” they chorused once more. After prayer, I offered the New Testament again. It was accepted joyfully.