Paul and Becca

We love you little one!

Nathan has been doing a lot of growing since we have been here.  He has been on the small side of the American growth charts since he was about 1 month old.  But here in Africa he is catching up.  He is eating 4 meals a day and several snacks, not to mention I still nurse him 4 times a day.  He eats oatmeal and fruit in the morning.  A banana for a snack, rice and sweet potatoes at lunch, animal crackers for a snack and carrots and wheat cereal at dinner and then some more veggies before bed.

He has started doing so many things just these past few weeks.  He can feed himself animal crackers and bananas and carrots.  Although the bananas are very slippery, he still manages to make sure every last bit gets in there.  It is so adorable to watch him feed himself and chew his foods.  He has also learned to clap, so we play patty cake.  And he can say mama, I think he knows what he means, but Paul says the verdict is still out.  I think he uses mama more as a I want something, please help me.  He can also give kisses, the baby version of slobbery open mouth kisses!  They are extra slobbery since he is about to get his two top teeth.  I am loving this learning phase.  It is so great to watch him learn so much so fast.

Oh, and he also got his first hair cut!  We set him up in front of his movie and gave him lots of animal crackers and he barely noticed I was there.

I just wanted to update everyone on little Nathan.  See below for Paul’s post for the week.

If Ethiopia had Halloween, this is how I imagine Nathan's Halloween costume. Isn't he adorable. I think he would love it! Notice that he is our stinker bug.

It’s been yet another full week here at Soddo. It started out with a visitor. Dr. Peter Meade came to spend a week with us due to his interest in serving with PAACS. He has spent much of his career training residents as an academic trauma/general surgeon in California. He recently moved to New Orleans with plans to work for a couple of years with the general surgery program at Tulane University. It was a pleasure having him with us!

Monday started off with the disappointing news that the sterilizer in operating room was not functioning and we did not have enough instruments/drapes/gowns/etc to operate on elective cases. We would have to save what we had for emergencies. The unexpected lull in activity allowed us to catch up a bit after the hectic weekend of trauma. On a very sad note, the little girl who sustained a bad head injury in the bus crash died this week. On another very sad note, another victim of the same crash also died this week due to a lack of a ventilator. He sustained severe rib fractures on both sides of his chest and simply could not adequately breath. We ultimately had to place a breathing tube, but, without a ventilator, had to use nurses to manually bag air into his lungs at the bedside. Unfortunately we could not sustain him. The lack of resources here definitely forces us to lean more than ever on prayer.

Ultimately the sterilizer was fixed and were able to resume our operative schedule. Due to the lack of cases done on Monday and Tuesday, the remaining days were busy but it was good to get back in the saddle.

Becca is pleased to announce a new creation at Soddo: veggie burgers! They are easy to make and they taste great! Another culinary newsflash, we discovered a nice little restaurant here in Soddo when Dr. Meade was visiting with us. Last Wednesday, after a heavy rain, 8 “faranji” (Ethiopian term for foreigners) slapped on rubber boots and made a muddy journey about a half mile from the hospital to a newly discovered restaurant. Becca, Nathan and I were accompanied by Dr. Meade and the Bowers clan (Harry, Stephne, Benjamin and Karmyn). We had Ethiopian food of injera bread, various types of stew and charcoal cooked beef. It was a delightful evening. As the power was out the entire time, we ate by the romantic light of one of our flashlights! It was great to get off the hospital grounds for a while.

Nathan has learned how to clap. Go on, folks, give him a hand. It’s always fun to watch him grow and develop. I’m so very thankful for such a wonderful family. It is truly a joy to come home.

Well, the demands of PAACS continue to knock, so I’ll have to get back to work. Till next week!

Paul

Everyone keeps asking for pics of Nathan... here you go

Welcome to the MEGA-POST! You honked, I listened.

The Introduction

Ok, I confess I’m not a very good blogger. Considering my grade in journaling from high school English, my old English teacher would say she could have predicted this. Please stop honking at me!

It’s been difficult trying to decide where to start first on the blog. Since coming to Soddo, I’ve seen more patients than I can shake a stick at but the big issues have been deeper than that. According to books and people who know, I’m starting to forge into the first real bite of culture shock. Frankly, it’s been kind of difficult for the last several weeks. It is rather difficult to describe without feeling like I’m just whining. The best way I can describe it is that, experientially, the whole is greater than the sum of its parts. When I look at all the little factors (different sights, smells, sounds, tastes, different cultural views on work, surgery, etc, new people, new places, stresses at work, loss of familiarity, loss of “places to hide and recoup”, new responsibilities, new challenges, etc), each one by itself is not that big of a deal. However, the accumulation sort of takes the wind out of your sails.

The good news is that I serve a wonderful God who has been gracious and merciful with me. Just as I have a hard time describing the challenge; it is equally difficult to describe exactly how much Christ has sustained me since coming here. Just as the challenge is nonetheless real, God’s strength for me has also been nonetheless real. I’ve seen a lot of good done here and the rough spots, though still quite rough, are slowly improving. More importantly we have seen lives changed. The Bible teaches that, without exception, every person has rebelled against God in sin and has therefore forfeited life. Each day that we receive before our natural death is simply a gift from His mercy. In the end, though, the only hope we have has been offered by Christ in His sacrificial death on the cross for us. He died and rose again so that we might be forgiven and live as well. We have seen patients enter the hospital in a state of spiritual death and leave with new life, changed forever by Jesus. That is very encouraging!

The Drama of the Trauma, a.k.a. Trauma-rama

I’m sitting here rather whipped on a Saturday afternoon after an eventful morning. When I accepted the (much appreciated) offer to work as a trauma surgeon for a year before coming to Ethiopia I had no idea how helpful it would be. As the great Clark W. Griswold of National Lampoon’s Christmas Vacation put it, “if I woke up tomorrow with my head sewn to the carpet, I wouldn’t be more surprised than I am right now.”

I was called at four thirty AM by the on-call resident that there was a patient with a bowel obstruction and by five thirty we were climbing into yet another obstructed Ethiopian abdomen. I have no idea how many obstructions I’ve seen here but it is quite common. Most of them are from bowel twisting on itself and kinking itself off. I suspect it is due to a combination of almost no fat in the abdomen and their high-residue diets. This case involved a part of the colon twisted on itself so severely, that it was as big around as my arm (which way to the gun show?) and very dead. By seven forty-five AM we had removed the dead bowel and given him a colostomy.

Hmmm, beets…

As I left the OR to see a few patients before one of our weekly resident conferences, one of the residents came rushing into the OR building to inform me that fifteen patients were in the emergency room after a bus crash and were in bad shape. He had one of them in tow on a gurney that was having a hard time breathing. After a quick examination revealing broken ribs on both sides and diminished breath sounds on one side, we pulled him into one of the rooms and placed a tube in his chest, allowing air and blood to escape so the lung could expand. Tasking the resident with settling the patient into our “ICU”, I quickly visited the emergency room.

True to billing, there were moaning, bleeding people on gurneys and benches everywhere. As a resident, I always sort of dreaded the day of the “mass casualty” drill at Baylor (sorry, Dr. Foreman). It’s kind of like when there is a hurricane approaching and, when you watch the news, you see an aerial shot of a highway. On one side, there is bumper to bumper traffic of people trying to get out of way of the storm. But on the other side, there is this one car travelling toward the coast with a surfboard on the rack? Those are the people that become trauma

surgeons. I, however, am one of the people in bumper to bumper traffic. I certainly did my best as a trauma surgeon, but, in all honesty, I earnestly hoped I would never see a “mass casualty”.

Oh, well. Now I’m quite thankful for those drills. I took a deep breath, recollected what I have been trained for and learned and, most importantly, tried to emulate what the Baylor trauma surgeons would do. After taking a quick survey triage with Dr. Anderson, the orthopedic surgeon, and Dr. Morad, the ob/gyn surgeon, we appointed the patients to either an OR room, the ICU or further evaluation by the generalist doctor in the outpatient department. Residents were assigned to the ICU, an operating room or the outpatient department. As I bounced around trying to guide and coordinate, the whole team really did a great job given the minimal resources. So far, I believe we have done all that we can. Most people are doing fairly well, though there is a young girl with a severe head injury for whom I’m very worried. Even with a real ICU, I suspect she would have a long road ahead of her, if she could pull through, but with no ventilator she may not survive. If you think about it, say a prayer for Bayush.

All in all, as “mass casualties” go, this was really quite benign. I’m thankful for the easy first run as it has given me good information on how to better prepare for the next one. That’s right, Soddo surgery residents, it’s about time for a “mass casualty” drill!

The Surgery “I’d like to phone a friend, Regis” Clinic

Most surgeons would agree that clinic is the necessary evil to get you into the operating room. Don’t get me wrong, we like visiting with patients (most) but operating is where the fun is. Clinic here in Ethiopia has added a whole new dimension of difficulty. If I can recognize half of what comes through the door, it’s been a good day. There have been a few days where I didn’t see a single diagnosis for which I was trained. It’s not uncommon to see a patient with some huge thing on the face, followed by a man with a crazy wound eating through his skull, followed by a woman missing half her toes with some another crazy wound, followed by a boy who can’t see out of one eye because the rainstorm that just happened twenty minutes ago involved a piece of hail that hit him in the eye (I’m not kidding), followed by a woman who is tiny and thin all over except, from the mid-upper arm down, she is the size of Andre The Giant.

And don’t forget the language issue. If there is a resident in clinic with me, it’s much easier because at least he speaks Amharic well and understands about medicine. Without a resident, it all goes through one of the nurses who, though very nice and helpful, don’t understand or speak English as well. (By the way, we are feverishly working on Amharic to be fluent someday circa 2040.) If all the patients spoke Amharic it would be great, but many only speak their tribal tongue. I’ve had many experiences where I have asked the nurse when was the patient’s last menstrual period, she then speaks in Amharic to the patient’s family member or friend, who then speaks to the patient in the tribal language, a lengthy discussion ensues going back and forth between the patient, the friend and the nurse, and is finally concluded several minutes later with the nurse informing me that her back hurts.

It is definitely a challenge! The sad thing, though, is how advanced everybody’s diseases are. We are seeing a lot of cancer here but, for the majority, all we can offer is palliation. For nearly all of these patients, the disease has already extremely advanced. Nobody just has a little melanoma. They all have massively swollen, ulcerated lymph nodes. We see a lot of esophageal cancer, but so advanced they can’t swallow anything. There is a lot of stomach cancer, but they are totally blocked off and have lost an extreme amount of weight. I’ve actually seen two cases of advanced gallbladder cancer here (I may have seen two in my entire residency).

Tensions run a little high in Amharic lessons...

Home, Sweet Home

However difficult the day, or night, may be, it is always a pleasure to come home. One of my greatest blessings from God is Becca. I wish I could adjust as well as she has! The other day I accompanied her to the local market with one of the ladies who works in our house and I was amazed at how much Becca looked like a pro. We wove through the thatched stalls and she pointed out all kinds of sacks of grains and beans and little things that were used for any number of foods. She is figuring out life here in a wonderful way and she is a true source of strength and encouragement to me. It has been so nice to come home every evening and spend time together. Nathan is growing up healthy and we both love watching him learn about life. He is such a cheerful little guy and a blast to play with. If only there was some way to harness his energy! He plays all day and sleeps all night.

We are really enjoying the other missionaries. It is nice to have a little community to share the times with, both good and bad, and I feel like our relationships are deepening. Again, I’m thankful for all of the supports that God has put in our life.

Thank You

Finally, I wanted to thank all the people who have been supporting us and praying for us. There are some amazing people back home who are really giving sacrificially to make this whole thing possible and we want you to always know that this is your ministry. We pray that we represent you well and that you are proud of us and what you are doing. You have encouraged us more than you know. Please keep prayin

Nathan's Jack Black impersonation from School of Rock

g!

In His service,

Paul

P.S. Becca proof-read this post and felt I should mention that I’m actually doing OK. Granted, I’ve lost a few pounds (you would too if your diet shifted from burritos and chocolate to vegetables and grains) and life has been a little stressful, but we’re happy and feel confident about coming here. I’ve even managed to hook Becca on a video game we can play together!

for those of you who know me, know that i love shoes.  when telling people we were moving to Ethiopia the first question they asked was, “are you taking Nathan?”  and the second was…”what are you going to do with all of your shoes?”  well, you will be happy to know that my pink crocs are perfect for over here.

i have someone new helping in our house in the afternoons.  her name is Hannah.  she has 3 boys and is just great.  being a stay at home mom with Nathan, i have really felt like one of my strongest ministries is with the women who come to our house. we spend time praying, learning each others language and learning how to cook American and Ethiopian food.

yesterday, hannah took me, Paul and Sharon (the new OB/GYN) to the market.  i told Hannah she should pick out a pair of house shoes for herself that she can wear when she comes over. (she walks an hour to get here an it is often through the mud.) she walked up to this huge pile of plastic shoes, i mean the pile was about as big as a small room…and she immediately picked out the most amazing pair in the pile.  she picked up one and i found the other!  and then she haggled the guy down to 20 birr (about 2$).  so here are the great house shoes…

we had a lot of fun at the market and it was great that Paul could get out and see the rest of Soddo, since he is usually stuck within the hospital walls.  speaking of Paul…i know you want to hear from him too!  come on Paul, what do you have to say?  honk if you want to hear from Paul!  maybe we can all peer pressure him into blogging a post soon….

The weather is so beautiful here. It never gets over 75 degrees and even when the sun is out there is a cool breeze.  From our patio we can see a large lake that is a few hours away and out the front door we can see a mountain.  We have a nice garden in the back and now that the rainy season is slowly drifting away the strawberries have started growing.  It hasn’t even peaked yet and every other day I pick about a quart of berries.  I have enjoyed learning a few things about gardening, although, pretty much the only thing I know is to pick the berries when they are red.  We also have a ton of carrots…I ate raw carrots everyday at lunch for 6 years while working at Baylor Medical Center and I think our garden could supply enough carrots for me and a few other girls at the table for at least the next 5 years. 

Alan is our gardener and he takes care of everything for our garden and the neighbor’s garden.  He is very knowledgeable and helpful.  Nathan and I take a walk around the garden every morning when we bring Alan some tea.  Which brings me to another topic…chai tea.  The Amharic word for tea is “shy” and although coffee is a big export to Ethiopia (apparently they ship all the good stuff to you guys in the states) tea is drank most often in the morning and coffee is a lot of times more of a ceremony that takes place in the afternoon.  They make what they call a chai tea and it is excellent and very simple, so I think some of you should try it.  It is basically cinnamon sticks, whole cloves and whole cardamon brewed in with loose leaf black tea.  Maybe it is also because I am several countries away from starbucks, but this tea is the best thing.  I have even converted from drinking coffee to enjoying this tea (with milk and sugar of course) in the mornings.

Well, people have been wondering what we are eating while over here, so a few things that were on the menu this weekend were…

Homemade yogurt, with homegrown strawberries, with homemade granola (I have to stress the homemade items, because I can’t believe I make those things either.)

Pizza and Calzone with mushrooms and a homemade dough of course

Oatmeal Raisin Chocolate Chip cookies (Delicious!!!) I will have to post the recipe in a side bar one day.

French toast (we bought the bread, thankfully we can get good French bread here for a dime a piece) However, the maple syrup was …you guessed it homemade!

Fettuccini Alfredo with garlic bread (this one was easy, I brought an alfredo sauce powder over and we had a quick dinner tonight)

And tomorrow night I am making Cajun Red Beans and Rice for about 20 people.  I brought some Cajun seasonings over here with me too.

So that is a little about our diet over here.  I have really been impressed with how much you can get in Soddo.  One of the missionaries even went on a candy bar run today on his motorcycle.  He brought us back a snickers!

Hope your weekend was good.

The new picture we posted on the top of this website was taken just before we left for Ethiopia.  Well, not at 3am when we left for the airport, but a few days before when we were hanging out with my parents in Galveston.    Thanks dad for the great pictures!

We spent the past Monday through Thursday in Addis Ababa. We were looking forward to getting away from the hospital for a few days, even though there was a lot of work to be done while we were there. We went with Duane and Jackie. He is the orthopedic surgeon who is helping Paul run the residency program and Jackie is starting an education building next to the hospital where people can learn English and checkout books from the Library. Sharon, the newly arrived OB/GYN came with us as well. She has been very busy and maybe has gotten 1 or 2 full nights of sleep since she arrived 6 weeks ago.

When we got there we stayed at a bed and breakfast called the Oasis. It is in a nice and quite part of town. There are missionaries who run the B & B and were very hospitable. They have an adopted Ethiopian son who is 2 ½ and Nathan loved to watch him and they played together very well.

The first night we were there we found the best Mexican food!!! It was great. The chef had lived in the states and I had a great burrito with fresh chips and salsa! And we had ice cream sundaes for dessert. We miss ice cream in Soddo. The meal was the most expensive one we have had since coming to Africa and with appetizer, dinner, cokes, dessert and tip it was about 20$.

The first day we were there Jackie, Jess, me and Nathan did a little shopping. Jess was leaving for Tanzania and then to return home to Minnesota. We already miss you Jess! After a little shopping where I got a crazy clock (5$) for our kitchen and a traditional Ethiopian scarf (about 2 $). After that you won’t believe where we went…the Hilton! One of the girls needed a hair cut and opted out of me doing it for now, so me and Jackie got pedicures (7$).

The next day Paul, Duane and Sharon met with the education department to work on getting the residency approved and accredited. They had some great meetings and were really thankful for the people they met. Nathan and I ran some more errands…which takes a lot of time. You have to drive everywhere and the traffic is thick and most places are pretty spread out. Silasse, the driver for the hospital van went with us and he is so nice. He would often entertain Nathan while we were running in some place and he even ate a hamburger for lunch with us and liked it. (This is rare for Ethiopians; usually they will eat injera for lunch and dinner and sometimes breakfast.)

We drove back on Thursday and were glad to get back to the clean air of Soddo. It really is beautiful here and we were glad to be home!

Love to all, becca

I have been meaning to post a cute picture of Nathan, so you don’t have to look at the dental job by Paul forever…so here you go…

As you can see, Nathan is super smart and is reading “Brown Bear” to himself.  He is such a cutie.

We spent most of this week in the capitol, Addis Ababa. We had a good time, but we’re glad to be home. It was nice to not have to cook for a few days. I will post more on our trip this weekend. For now, it is nighttime here! Becca