Watengo

We woke up like any other day. We have traveled so much in Ethiopia, that road trips almost feel normal and typical. The 100's of donkeys, carts and people on the two lane highway from Soddo to Addis Ababa almost felt ordinary. But perhaps it is when we take down our guard, and forget to stay vigilant in prayer that the enemy attacks.

We were taking our friends to the airport this quiet Thursday morning. We ate breakfast before we got on the road. We stopped to get a hand of those cute apple bananas for our friends in Addis from a young boy on the side of the road. We made it about 45 minutes out of town, when it happened. We were out of any official town between Shone and Halaba. We were headed downhill on a beautiful stretch of road with some small ravines on either side of the road. There was no person or animal on the road, except Watango. Watango is a 75 year old muslim man with significant vision impairment. He was walking along the side of the road for his 10 kilometer trek home. As we traveled down the road, we gave a polite, "I'm here" honk. Watango went from walking, to running and darted across the road. We braked HARD, honked LOUD and swerved to miss him, but unfortunately our side view mirror, and maybe our tire hit him. He fell to the ground. We skidded to a stop just at the edge of the steep bank next to the roadside. Literally our tires stopped a few centimeters away from the side of the road.

The car came to a stop. Adam and I ran out of the car to his side to see if he was alright. No one was around. Adam went back to get some gloves and our first aid kit. He is wearing dirty, well worn clothing that has been repaired and repaired at least 4 times. I noticed some blood from behind his leg. He had a degloving injury about 9cm long. I quickly put some pressure on his leg, bandaged him with gauze and wrapped it with an ACE bandage. Otherwise he was stable. He was having some pleuritic chest pain, especially on his right side, but her heart rate was stable and as far as I could tell he was mentating well (he doesn't speak either English or Amharic). The first person to come to our side was a local Ethiopian Catholic priest. Then lots and lots of people came to see what was going on. We had about 60 spectators. No one tried to harm us, or harass us. (Locals have been known to throw rocks are try to harm the driver after roadside traffic accidents).

The crowd watches peacfully as the police start their investigation

We called our hospital to arrange for transport for Watango to our hospital and our friends to continue on to Addis without us. We went back to the Shone police station to give our report and start the paper trail. With the help of one of our hospital administrators, we were able to convince the police Sargent to allow us to escort Watango to our hospital. We drove as a family with an Ethiopian police man and his loaded machine gun the 45 minutes back to Soddo, as we traveled behind our hospital's ambulance.

Watango was evaluated in our hospital with all we could do... FAST scan, CT scan, blood work, xray. Praise the Lord, he had a cartilagenous rib injury and a posterior tibial degloving injury... no broken bones or bleeding in his head! I can not describe the relief.

I stayed at home with the kids, cried a bit, but mostly tried to hold it together, while Adam gave his report to the police. Adam then had to take the car and the police officers back to Shone to complete some paperwork. He came home, without our car late that night... but he came home. It is very common for the driver to have to stay in jail at least one night after a roadside accident. The driver is always financially responsible, and additionally, everyone is considered guilty until proven innocent. But, with our administrator and favor from the police, Adam was able to come home.

That night we had one of our local general surgeons escort us back to the hospital to talk to Watango and his family. As we walked in, we both feared anger, hatred and a very hostile environment, we were met with love, and blessings. We explained who we were, and that we would help to take care of all his medical bills and that we were praying for his full recovery. In return, Watango's brother spoke repetitive words of blessings over our family. He told us he prayed that we would never have an accident like this again. He reported that he could tell that we loved his brother very much, as we were taking such good care of him at the hospital, and we stopped by the side of the road to care for his wounds. It was one of the most humbling experiences of my life. I was expecting shame and anger and instead received love and mercy. In this advent season, it is so reminiscent of the total undeserving grace and mercy we receive from our Lord daily.

We arranged for Watango and his family to get food and to make sure he got all the medications he needed. He is very poor and there is no way we would be able to afford the medications and care from the hospital without our help.

Watango is still here 5 days later. They are trying to determine if he needs skin graft on his leg. We go to visit him and his family daily.

The words of love and encouragement that we have received from our friends and family are that this horrible event, this tragic occurrence, did not happen without a reason. One of our young friends reminded us that God was not sleeping when this happened. Adam's mom and other have encouraged us that God is going to work good out of this situation. And we have both felt the strong desire to abundantly bless this man and his family. We desire to show him the healing and abundant love of Christ though this entire process.

Tomorrow he goes to have his eyes evaluated by our optometrist to see if he is a candidate for cataract surgery. Wouldn't it be amazing to offer him the gift of sight. We pray that through this time he would be able to physically see again and see the abundant love that Christ offers us daily. 

The current of life in Ethiopia

This was the perfect scene from the hospital last week. We all attended "chapel" this morning, which was really the graduation ceremony of our general surgery residents and one of our well loved general practitioners. We had two graduating residents, speeches and lots of tears of joy as these two young surgeons get ready to leave the hospital to serve the people of Ethiopia well. It was so sweet and a sweet reminder of why we do what we do.

The chapel is right next to the morge. There was an adult patient that died at the hospital last night, and his coffin was being carried to the morgue until the family could take the patient's body home. For 45 minutes of the 60 minute ceremony there was deafening, loud wailing as the family mourned over this man's body.

This is life here. It is sad and strange that there is so much joy and so much sorrow that can almost seem to happen at the exact same time. It is a weird emotion. The most interesting thing about it all is that it seems like life here is like that a lot. In the midst of joy, there is always an existing current of sorrow. Life here is hard. And Ok, really the most interesting part about the morning was that no one else really seemed to notice the wailing.  Perhaps I'm just one of the newest to life in Ethiopia, and for everyone else it is just normal.

Dual mindedness

Oh the joys of living overseas and feeling neither like an American and neither like an Ethiopian. Sometimes it is difficult and other times it is just funny to see the culture clash. 

A few weeks ago we had a team that came to visit us at the hospital and brought cloth diapers for the newborn babies and the pediatric department. One of their team members had come before and was moved in love and compassion that all the babies soiled rags with urine and stool, for the mother or helper to hand wash and change again. The beds get wet, the mothers get wet and the child is covered sometimes down to their cute little baby feet in poop. So this team decided it would be so much better, and more sanitary if we had reusable cloth diapers for the wards.

They got everything all set up and gave their specific instructions to the cleaning staff. I happened to be their to watch their interaction... all translated by our local Ethiopian IT worker, who knows nothing about cloth diapers, but he speaks english. 

"So what you need to do is fill up some buckets and fill them with hot water for the patients to put the diapers once they are dirty."

"But our patients will just put trash in the buckets." 

"Well, maybe you should label it: for dirty diapers only."

"We have tried this before and our patients just put trash in the bucket."

"Well, put some tape on it with specific instructions about what should go in which basket,"

"We have, and a number of our patients can't read."

"Well they will see."

"But we have tried and it didn't work. I can show you the basket with the amharic writing on it that says for dirty diapers only,"

"We should try again."

"And most of our patients don't know what a diaper is? Or know what to do with the plastic covers."

"We should teach them."

"But we have tried and then the dirty diapers and the plastic pants all went down the pit toilet and clogged the septic system."

"Well, we just need to teach them."

"But"

and she walked off to distribute the cloth diapers. 

Fear

Why is fear such a great weapon. It feels like it is everywhere, and so easy to get sucked in, especially with young children.

Since our return to Ethiopia, as the mother of sweet 2 year old Cole and little 3 month old baby Leah I have had moments of overwhelming fear, crippling fear, and even I want to run as far away from here as I can fear.

I was doing ok. I could handle the every changing expectations, the non-functional car, being left alone to care for the hospital compound and the hospital for a few weeks with the others traveling, but when it comes to my kids, it is so easy to get overwhelmed and spiral out of control.

Just as I started working in the hospital more than I intended, and the majority of our western neighbors left, there was a new article about aflatoxin in all diary products in greater Ethiopia. https://aghealth.wordpress.com/2015/07/20/new-ilri-study-finds-high-levels-of-aflatoxin-in-milk-and-dairy-feeds-in-greater-addis-ababa-milk-shed/

I felt like a horrible mother, who is some way brought her family over to Ethiopia, just to give them huge quantities of aflatoxin, that may cause liver cirrhosis or liver cancer (and I have a real fear of liver disease after a very close patient of mine died on the liver transplant list). I had been giving Cole the milk here and the local cheese and yogurt for the last year, and ate it while I was pregnant with Leah. What have I already done, when I didn't know? What am I doing all the time without realizing it? Can I trust anything to eat here? What should I feed my family? I wrote to a friend and told her, "I know God has called us here, but it makes me want to run "home" to keep my family safe."

Then that very next week, I had to travel to Awassa to sign some papers for the hospital. Awassa is in a low lying plane, next to a lake with endemic malaria. I figured it would be ok to go and take Leah because she would need to eat and as long as we were only there during the day we could avoid the malaria carrying anopheles mosquito that only come out at dawn and dusk... until it took longer than we anticipated and we left after dark. AND THEN Leah came home with a mosquito bite. All the fear came rushing in again. Did I just give my infant daughter malaria? (and I have a real fear of malaria after a friend of mine lost their 6 month old to malaria in Chad). Why did I let myself go there in the first place? Was it worth it? If I didn't go the hospital would have had to shut down. But my daughter's heath is not worth the price. I couldn't sleep for days fearing the dreaded fever that might ensue.

WHY do I let fear consume my mind? It strikes deep in the heart of my mother's heart. During this process I have had to draw nearer and nearer to God in prayer, especially in the middle of the night when it feels the hardest. YET he has called my family to Ethiopia and I will trust him. He is victorious and has plans far greater for our family and Ethiopia than liver disease and malaria. There is a hope that goes beyond sickness and health. It enters into the hope that comes only from the spirit. The hope of eternity in perfect union with our Lord. Sometimes that hope feels like a hard pill to swallow, but I remind myself, over and over and over again...

Romans 15:13. May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.

Psalm 91: 3-6
Surely he will save you from the fowler's snare and from the deadly pestilence.
He will cover you with his feathers, and under his wings you will find refuge;
His faithfulness will be your shield and rampart.
You will not fear the terror of night, nor the arrow that flies by day,
nor the pestilence that stalks in the darkness, nor the plague that destroys at midday.

the white picket fence

One night Adam and I watched the beautiful Ventura sunset on a warm night from the top of Grant park overlooking the ocean. In one of those moments we thought to ourselves, "what were we thinking? Ventura is awesome! Why did we ever leave? It's beautiful. You can walk places without being followed or asked for money. The weather is amazing. The grocery stores and restaurants fast and delicious. There seems to be a sense of stability here. We could have a home and have stable friends and be near our family.  People can live out the american dream. It is so much easier to rest here. What were we thinking???"

And then we are reminded that the Lord has called us to be obedient to his call. For this season we are called elsewhere. Although the view in front of us seems so much better, there is more. God has promised us that.

Matthew 19:29 

And everyone who has left houses or brothers or sister or father or mother or wife or children or fields for my sake will receive a hundred times as much and will inherit eternal life. 

Then one of my mentors and long time missionary to Africa for 25 years published this in his blog (written by his wife). 

http://dahlmandiary.aimsites.org/2015/07/17/just-do-it/

(YOU SHOULD REALLY READ THIS)

She states the same. The challenges, the transition, the fears are WORTH IT. Even after I read the scripture of God's promise, hearing it from someone else encouraged me to stay focused. It encouraged me to "not be content to live in the shadows of an ordinary, lamp-lit life when the full color sunshine is out there, just around the bend, over the next horizon, with your name on it."

Family Medicine Residency Development

"Not by might nor by power, but by my Spirit,’ says the LORD Almighty.” Zechariah 4:6.

Years ago, I had prayed and prayed over the decision to apply to medical school. I either felt like the Lord was calling me to be a doctor or a teacher. At that time, the Lord asked me, “Michelle, why can’t you be both?” Since the beginning of my medical education, I knew that my heart and passion for medicine goes much deeper than just seeing patients and caring for them through their medical problems. I always knew that I would be a teacher in some context.

As a family we prayed over the where the Lord would send us. In 2012, There were rumblings of a family medicine residency in Soddo, but those at Soddo Christian Hospital made it very clear that SCH was in no way ready or planning to start a family medicine residency any time in the near future. God confirmed that we were to serve at SCH and we moved to Ethiopia in 2014, still with no plans to be formally involved in a family medicine residency in Ethiopia… so I thought to myself, I’ll do this term and then come back and join faculty somewhere in order to teach, as I had originally felt called years prior.

Then, in Ethiopia where the bureaucracy is thick and the paperwork tall, things started spiraling into control. In March 2015, the ER patient volume reached critical mass and the administration and executive board of SCH realized we needed more workers. They asked a team from our hospital to attend a family medicine networking conference in Addis.  The conference was good, but left more questions than answers in many regards.

As the barriers to a family medicine residency were investigated, they all started to melt away. A short two months later, things were moving and shaking. There was concern about finances… an outside organization, Project MedSend, reported they may be able to help finance some of the residents salary. There were concerns about curriculum… the SIM family medicine faculty were battling the same questions and trying to move forward in a thoughtful and diligent way to encourage the strong growth of this new specialty in Ethiopia.  There were questions about how SCH could supply all the rotations and subspecialties well… Myunsung Christian medical Center was excited and enthusiastic to partner with us. There were concerns about no family medicine physicians at Myunsung... an American family medicine physician just contacted Myunsung after the Lord moved his heart at a missions conference. There were concerns about government approval… we quickly received a glowing letter of support from the federal ministry of health to the residency accreditation board (HERQA). There were concerns about HERQA’s perspective on the program… one of our orthopedic surgeons went to advocate to HERQA for our family medicine residency and possible new ortho residency… the HERQA representative knew him and in fact had a friend upon whom he had operated with outstanding results. Such favor!

There I was, just two short months later, not really sure where everything was headed, but realizing that God was moving. Before every question arose, an answer was already rising. It is here that I sat and wondered at my own lack of faith. Every obstacle felt like an insurmountable barrier… just to have a quick answer to that barrier already prepared by the Lord.  Why I continued to doubt, I don’t know! It has been an emotional roller coaster, and yet God has been sovereign. I still don’t know what the outcome will be. There are a lot of details yet to finalized, but I can be confident that God is in the details and working. Every step of the way, he is strengthening my faith.

As I lay down one night, feeling totally incapable and inadequate as a young female physician, 33 years old, tired, pregnant and on the brink of something way bigger than myself, the Lord reminded me, if this happens, it is not because you are capable, it is because you are dependent on me, and I am able. It is not through your power or might, it is through MY Spirit. I desire to teach Ethiopian physicians. I desire to disciple them to be strong God-fearing men and women. I desire for the people of Ethiopia to know my love.

It was there that I felt the lightness to take a deep breathe.  It was as if I stood on top of a mountain, forged by the Lord, overlooking his master piece. I felt totally overwhelmed, yet totally at peace. Realizing that the dreams the Lord placed on my heart so many years ago were small. As I walked along the path the Lord has prepared, not only does he desire for me to be a teacher and physician in the traditional sense, but also to encourage spiritual maturity and create disciple makers at the same time. This is a job description and joy far greater than I could have ever dreamed.

“Now all glory to God, who is able, through his mighty power at work within us, to accomplish infinitely more than we might ask or think.” Ephesians 3:20

Home Assignment, furlough, maternity leave, oh my!

During the preparation for our trip back to the US we have had a lot of reflections and thoughts about how to spend our time in the states. One thing that we have found to be helpful is to pray over what God desires for us to accomplish or do this summer. In the "missionary community" there are a lot of words that float around. To be honest with you, it can be confusing at times. Some people will describe this season as furlough, others as home assignment, others may call it vacation and for us, maternity leave. 

On our departure, we prayed over all the possibilities of things that we would "need" to accomplish while we are in the states this summer: Do we need rest and renewal? What about the delivery of baby #2 and bonding with our new baby? Do we need to learn new skills to take back with us? Do I have to do any medical licensing work requirements(CME)? How should we reconnect with friends and family? How do we need to report to our sending church and supporters? What about future missionary recruitment? Will we have more financial needs after this summer? Will we need to raise more money? How should we continue the work from Ethiopia? What medical services do we need? (like vaccines and dental visits) There are a lot of possibilities, but Adam and I thought it would be best if we could pray over what God wanted us to do to keep from feeling so overwhelmed with the possibilities. 

It has been a difficult process for many reasons. We sometimes have a sense of obligation to do something. The process has involved trying to separate those feelings of obligation and pray over what God would like for us to do or learn. We then came up with a practical strategy (as much as possible) to give space for these things, to determine where to spend our time, and with whom. It has been helpful to talk about this with all our support organizations: Reality church, Christian Health service corp, St Luke's health care foundation and the hospital staff. That way we can have very clear expectations all around.  

It has been very easy to feel lost in a "new" culture, with "new" homes and "new" roles. It was so helpful to identify the purpose and goals of this season of life so we can walk in it fully, without feeling quite so overburdened, guilty or stretched. 

This summer we feel like God called us to have a "home assignment" where we reconnect with our supporters stateside and complete a few tasks for Soddo Christian Hospital until our little one arrives. Then when she comes, we can prioritize our immediate family and have some family bonding before we return to Ethiopia in the fall. We pray that this gives us the time, space and resources to be able to run the race. 

"let us run with endurance the race that is set before us, looking to Jesus, the founder and perfecter of our faith, who for the joy that was set before him endured the cross, despising the shame, and is seated at the right hand of the throne of God." Hebrews 12:1-2

Success as a physician in Ethiopia

So this is the beginning of many thoughts and blogs that I have wanted to write, but never had the time for. The Lord encouraged me to write them, even though many months later, to remind myself, and anyone else who reads them, of his faithfulness during our journey.

One of the biggest challenges I have had to face is the constant illness and death. It is all around in Ethiopia and at times can be overwhelming. As I entered our time here I didn't realize how much of my sense of being a "good" doctor or successful at my profession was very western. I found that I judged my success based on my patient outcomes. In a hospital where death is no stranger, it was very easy for me to feel "bad" at my job and found it difficult to remain hopeful and optimistic as things felt futile and felt inadequate.

But the reality is that my success and worth is not measured by patient outcomes, and if patient's live or die. My success is measured by how I can make a difference in the circumstances in front of me with what I have. When patients show up late in their disease, there is only so much I can do. Or when they need medications I don't have, I can't take it personally as failure, but that I am doing the best I can. My success is in teaching the nurses, the midwives and the residents (we have general surgery residents) medical knowledge. My success is in loving my patients well, despite their circumstances. My success is in being kind to those around me and showing the light of Christ even in the darkest and most stressful situations.

And my worth and identity is found as a daughter of Christ. That identity exists because of who God made me to be, not based on what I do or what I accomplish. You are chosen, you are God's special possession. What a privilege to remember this especially in those dark places.

9But you are a chosen people, a royal priesthood, a holy nation, God’s special possession, that you may declare the praises of him who called you out of darkness into his wonderful light. 1 peter 2:9

Coming "home"

We are preparing to come home for the delivery of baby #2! What a joy and WHAT A STRESS! It is so interesting to watch my heart change and see all these unexpected changes occur. All the other times in my life, returning from an international location to the US what exciting and full of a sense of familiarity, after a time and season of distance and unfamiliarity… NOT SO THIS TIME.

And it is even more complicated because we are still in transition. We are still in temporary housing. Our belongings are not in drawers, because we have none (we are living in someone else’s house). The house we will live in is still not complete (now 5 months late) but should hopefully have a dry room for us to store our belongings in during the rainy season while we are away. Ultimately, I cannot tell if we are leaving home or going home. Where is our home? What is most familiar?

This is even more complicated because Adam and I have started many new projects at the hospital and developed many new relationships. It is difficult to be starting something, and in the beginning of it, to walk away for 3-4 months. It is difficult to tie up all the loose ends before we leave… because there are a lot, in order to have these projects continue in our absence.

Earlier this week I was feeling so overwhelmed by it all. Today, I was in our women’s bible study as we sat down to study 1 Peter and the Lord encouraged me that this is hard, but we are meant to be strangers in this world. And that at times, there will be suffering, but that is ok, because even though it is difficult, he will always be faithful and we should rejoice because through this process we are being purified. As a child of divorced parents, I always, always, always desired for one home, for consistency and for a  feeling of permanence. I never really saw this as a bad thing, just a part of my personality and the result of my childhood experiences. The Lord had encouraged me and challenged me this week… maybe a sense of consistency and permanence should not be my goal in life or where I feel most comfortable. Perhaps, this process has refined my heart and my mind to desire more of the Lord and to always be Kingdom focused, because that is where our true permanence lies. Heaven is where our true sense of identity and home NEEDS to be, not here. And in this “homeless” state that our family walks, this fosters a greater desire for our true home! Thank you Lord for that reminder, despite the difficulty of it all.

Multicultural kids

I am sitting in Addis Ababa, the capital of Ethiopia.
I am sitting at Han restaurant, a delicious eating delicious authentic Chinese ( like China, not panda express) food.
I am sitting watching Cole run and play in front of the Chinese restaurant with a Russian boy who he can't share two words with but the joy in their play tells me they are communicating just fine.

Cole is going to have some really unique experiences growing up here in Ethiopia. As we live here we will meet people not just from our own culture and our host culture but all different people who have left their homes and are traveling this world.

I hope this has gives Cole eyes for seeing that the world is really big but we who live here all share a lot in common and that God loves all of us.

Week in Mozambique

Dr. Jeremy and I are in Mozambique this week!  We are here to learn more about OpenMRS, a software project that we are using at the hospital.

Electronic medical records in Africa? Crazy! We are a pretty advanced hospital trying to do excellent care for patients in rural Ethiopia, so we are looking for ways to improve health delivery here. Electronic medical records will help us answer questions about it patients and care that will help us improve care and systems in the hospital.

After a pretty exhausting 2 weeks of dealing with governments to get our paper work all squared away, this week is not coming at the best time for our family. But all the pieces feel into place and here I am. I miss Michelle and Cole a bunch but we are able to talk on Viber so wee can stay connected this week. I hope the time at the conference this week will help me get ready to be more useful at the hospital. 

It's my first time in Mozambique and all of a sudden the air feels like I'm really in Africa. Temps in the 90s with lots of humidity. We are right next to the ocean and I'm looking forward to some yummy seafood. They speak Portuguese here and I was hoping to be able to use some Spanish knowledge to come up with some usable phrases. But, I have realized that my Amharic is pushing out my Spanish from my head so I am stumbling to come up with anything. Crazy how language works....