Gimbie Reports

Gimbie Adventist Hospital is blessed with many competent nurses and doctors. But for a number of them, healthcare is little more than a job. That’s not the way it is for Dr. Priscila Ara, our new general practitioner from River Plate Adventist University in Argentina. She takes a personal interest in her patients and goes far beyond the call of duty. The other doctors give her puzzled looks when she takes patients by the hand during rounds and hand-feeds ailing children. But her example is powerful, and she is lifting the standard of care to a whole new level. Nowhere has this been more evident than with baby Aster.

Baby Aster arrived Sunday, two days after she was born at home. The parents didn’t know what was wrong, but she hadn’t been breastfeeding and was acting listless. She arrived at the emergency room dehydrated and with a very distended abdomen. What Dr. Priscila first noticed, however, was Aster’s cyanosis. Priscila scooped the baby into her arms and ran downstairs to the female ward, where the oxygen machine was located. She fitted the tubing over Aster’s head and under her nose. Then she watched as the baby’s oxygen saturation rose: 35 . . . 42 . . . 50. . . .

Aster was admitted, and Priscila spent much of the afternoon and evening tending to her and reminding the nurses to check her vital signs and replace her IV bag when necessary. At one point, the electricity cut out, and Zach Barlow made a mad dash for the generator as Aster’s oxygen level dropped. Later that night, Scott Barlow stopped by to check on the baby and noticed that she was blue again. Upon closer inspection, he saw that because of the butter in her hair (a cultural practice), the tape that held the oxygen tubing had slipped. He quickly fixed it and lectured his nurses about watching Aster more carefully. Somehow Aster made it through the night.

On Monday Aster’s condition didn’t improve much. Priscila spent many hours with the baby and her family. That evening she came to our front door with a very distraught look on her face. “Me ayudás con la nena?” (“Would you help me with the baby?”) she asked me. I knew exactly which “nena” she was talking about. I put on my shoes and ran out the door to translate for her.

There was confusion between her and the surgeon about whether or not the baby should be operated on. The first step in making a decision was to get an x-ray. The oxygen machine couldn’t come with us, so we literally ran to Radiology: Priscila carrying Aster, a nurse carrying the IV bag, and me carrying an ambu bag, just in case. The baby had to be x-rayed in an upright position, and the nurse wasn’t willing to help. So I donned a lead gonad shield and stood on one side of Aster to support her arm and head, while Priscila stood on the other side, holding the baby’s other arm and lower body. It seemed like an eternity as Aster wriggled in our arms, turning bluer by the minute. Finally the technician snapped the x-ray.
We ran back to the ward and reconnected Aster to the oxygen. “36 . . . 45 . . . 57. . . .” Her oxygen saturation didn’t rise above 75, at least not in her foot where the monitor was clamped. Her x-ray revealed intestines inflated with air and clogged at the end with meconium. The surgeon decided she was too weak for an operation, and we didn’t know if she would survive the night. We called Petra to pray over the baby and minister to the family.

Baby Aster did survive the night . . . and the next day . . . and the next night, with Priscila by her side almost continuously. Whenever somehow asked, “Where is Priscila?” we’d respond, “Check the pediatric ward.”

Baby Aster passed the meconium, and her abdomen returned to normal size. She started breastfeeding and growing stronger. She went home Thursday morning with two very happy parents.

We at the hospital can hardly express our gratitude to God for sending us such a dedicated and compassionate doctor. Without her, baby Aster almost certainly wouldn’t be alive today.

Check out our new Web site at gimbie.wordpress.com.

Renee's done a great job with it!

Today I drove a girl home from the hospital. Her family wanted her to die at home. I drove the green truck very carefully, trying to avoid as many of the bumps as possible. Every so often her family and the staff who had come to help with the stretcher and try to provide comfort had to get out so I could drive across a stick bridge or make it up a steep hill. I did my best, but she still cried out in pain.

Seventeen-year old Asaitu didn't know that by choosing to become intimately involved with her friend would lead to pregnancy. Trying to salvage her reputation and get rid of her "problem," she decided to try to self-abort with a stick. She had no clue about the consequences of these decisions. How could she have predicted that she would get an infection, that her left leg would become gangrenous and have to be cut off at the groin, and that the infection would spread to her other leg, sealing her fate?

Sleeping with her boyfriend and then having an abortion; obviously bad decisions, but still, two mistakes and now she has to die? Why does she have to bear the brunt of her choices, and so many other people don't? I've sinned before, and I'm still alive; why her? These are the thoughts that whirl in my mind as I grip the steering wheel tightly, trying, by sheer determination to keep from jarring the stretcher balanced on the bed of the truck.

Later, at her house, I tried to think of a scripture to read. All I could think of was "Even though I walk through the valley of the shadow of death, I will fear no evil, for Thou art with me." Scott Barlow, the hospital matron, shared about the hope we have in Jesus, and then prayed and annointed her. A few Ormos also gave little sermonettes while the flies gathered and the sweat dripped from our faces.

Most of the people who rode back to Gimbie with us weren't notably sad. In fact, one boy asked me if I was all right. Life is difficult, he said. Yes, I guess so.

So, I keep living, meeting my own challenges, making my own poor choices. I don't often think about the consequences of my decisions. I usually just do whatever seems best to me, given the information I have.

So did she...

Joel

Priscila, our new Argentine doctor, is here. She’s fun, competent, and passionate about her work here. The only problem is with her English.

Yesterday I translated for her in the ER. We saw a really dehydrated baby who hadn’t had a bowel movement in 3 days. He’d been vomiting for a week and was crying with no tears. Between the two of us and the practical worker in the ER, we managed to get the baby admitted.

Then there was a 16-year-old girl who came in with pelvic pain and excessive vaginal bleeding. We had to get the family away in order to ask her if she could be pregnant. She said she wasn’t pregnant but admitted to some sexual activity a month prior. Priscila had a hunch it was a miscarriage and sent her to the OB/GYN. As soon as the girl stood up, she collapsed from the anemia. (The underside of her eyelids were as white as milk.) It turns out she had been pregnant, and she knew it. She had provoked the abortion and punctured her uterus in the process.

At least her prognosis is better than that of the 17-year-old Adventist girl who tried to pull the same stunt two weeks ago. She ended up with a terrible infection that cost her a leg. Today the doctors decided the infection was so bad that her case was hopeless. They loaded her into the back of a pick-up truck this afternoon, and Joel drove her home so she could die there rather than in the hospital.

For these girls, the risk is worthwhile. If they’re found to be pregnant out of wedlock, they can be disowned. They’re left with no support from their families, no hopes of marriage, and definitely no welfare check.

I spent last week in Addis presenting at a national HIV/AIDS conference and meeting with government officials. Priscila, a GP from Argentina, arrived on Sabbath morning and Fletcher’s sister Emily arrived on Sunday evening, so I decided to stay in Addis until Sabbath morning, pick up Priscila, and head to AWASH Park until Sunday night, and drive to Gimbie on Monday. Tom and Denillo of ADRA Norway came with Petra, Priscila, and I to AWASH.

The road out of Addis to AWASH was under construction and I had to forge a detour through the slums to get back on track. We had hardly regained the main road when the rear wheel of a large truck in front of us came loose and started rolling down the road. The road had a significant grade so the wheel picked up speed as it traveled through several food and craft stands. It smashed into an electric pole, knocking down wires and causing a shower of sparks. People literally dived out of the way as the wheel headed back onto the road, hopping curbs and cars before finally coming to rest on the sidewalk.

A huge sugar cane plantation was recently started on the border of AWASH, driving the Afar nomads and their thousands of cattle into the park to find grazing. The tropical oasis we visited in December has become a cattle clogged dust bowl. We had scarcely reached the hot springs and started swimming when a massive dust storm, complete with thunder and lighting, reduced visibility to a few feet. We tried to stay in the water to avoid the dust, but Tom stayed a little too long and fainted.

Oddly enough, the lions have been driven into the park by the sugar cane plantation as well and their nearby roars were clearly audible through the thin walls of Petra’s cheap tent. Next morning we tracked them for several miles but eventually lost the trail in tall grass.

The return to Gimbie was comfortable enough until we reached Nekempte, were Karessa (druggist) joined our seven member group with pile of medicine. Much of Nekempte is under construction and I had to do some serious off roading just to reach the pharmacy wholesaler. Once we were fully loaded there were three people in the front seat, five in the back seat, and the behind the backseat was packed to the roof with meds. On top of the roof we had all the baggage, more meds, and three new mattresses for the hospital.

The five foot stack on the roof did nothing to help our fuel mileage, which was a pity because Ethiopia is having a fuel shortage at the moment and I had been unable to find fuel on the way to Nekempte. By the time we rolled into Gimbie both tanks were well below empty.

The power just went out and we are running the generator with what fuel we have left. We’d siphon from the ambulance, but it is at Mugi clinic. I hope they find enough fuel to get back for the weekend. Mark will soon have our new 10,000 liter fuel tank installed so we should be able to dodge this problem in the future.

Maternity World Wide’s Safe Birth Fund has caused a dramatic increase in the number of births at GAH, saving countless lives. We have so many beds in the female ward that there is hardly room to walk through.

Our surgeon (Ethiopian) must leave soon to honor commitments with the government. I am scrambling desperately trying to find someone to fill in once he leaves. The director of our nursing school has similar problems. And both our Ethiopian GPs will leave in three weeks. Not to mention the issues with the nurses. The only way to survive here is to live one day at a time. As Girma likes to say “everything is miraculous, there is nothing common for those who work for God.”

Ah good, the power came back. Now if it will just stay on until we can get some fuel…

Paul

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 idly by.

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.

Paul