Paul and Becca

This is an admittedly difficult subject to write about, especially in a public arena. My hope is to communicate a sensitive subject that could be misconstrued by readers from different cultures, whether they are Western or Ethiopian. So I pray for grace and humility. Ultimately, my reason for writing this is to request for prayer that God would grant me His love, grace and wisdom to faithfully carry out what He wants me to do.

Since taking over leadership positions with the surgical residency and as the medical director, I now find myself dealing with lots of conflict resolution. Sometimes it is conflict between people and systems and sometimes it is between people and people. Sometimes there are problems between people of equal status or positions and sometimes the people are of higher or lower status or positions. In all cases, though, the resolution is rarely easy.

The greatest challenge comes from cultural ignorance. The whole process seems kind of crazy and doomed to failure when everyone seems to understand the unwritten rules except the arbitrator. It’s kind of like two soccer players getting into an argument about the game and calling on a baseball referee to make the call. The referee may understand some basic principles that are essentially universal across sports but he is forced to look at soccer through baseball lenses and the outcome would probably not be ideal.

So issues of conflict arise from all possible combinations of parties and I basically don’t understand the rules of what is right and what is wrong. When I apply the rules I understand from my own cultural background, the results are often ugly. I find myself very reliant on wisdom from other Ethiopians but they themselves still want me to make the call. There have been many instances where an Ethiopian presents a problem to me and seems fairly disappointed when my first response is, “What do you think we should do?” Of course, the disappointment grows even further when I’m finally pushed to give my opinion.

The whole process is made further onerous when emotions are thrown in. From what I’ve learned so far, it seems that Ethiopians don’t engage in direct one-on-one conflict very often, whether it be of a personal nature or professional. The route for such engagement seems to flow through positions of authority. You don’t talk with the person; you take it to the boss. Now, coming from the American setting, I am familiar with such a view point when the conflict is professional. I’m used to it and I expect it. However, this is quite foreign to me from a personal level. What really makes the situation volatile, though, is the American viewpoint of how personal issues ought to be dealt with, namely mano-a-mano (man-to-man, for those unfamiliar with the phrase). This is true across the board but even more so with literal males. There is a sense of weakness when people can’t handle their personal issues and have to take it to a third party. And it’s even more pronounced when males are involved.

Now, there may be some element of this in many cultures, but I suspect there is a distribution regarding how much; sort of a bell curve. I would suspect that Americans are near the upper end of that bell curve of all cultures. As if it were needed, however, my situation is even further complicated in that, among the distribution of this effect even within the American setting, which is on the high end of all cultures, I personally am near the high end of even the American bell curve. When one man comes to me to complain about how another man is mean to him or doesn’t respect him, my first instinct isn’t to say, “Hmm, that’s tragic! Let’s talk about it.” My first instinct is to slap him and to tell him act like a man and deal with it.

Let me be quick to say that this is not a good or admirable instinct, nor even Christian. But unfortunately it does describe the bend in my fallen heart. On the other hand, I’m not saying that the Ethiopian understanding of conflict resolution is ideal either. The real challenge is discerning the ways that honor God and submit to His authority as defined by scripture.

But it also unfortunately describes a bit of my day-to-day difficulties as a leader in a hospital and a surgical residency. (As an aside, the American surgical residency is one of the more entrenched environments of the ‘suck it up and be a man’ mentality.) So, whether I’m hearing complaints about how the hospital is treating employees or employees are treating employees or the residency is treating residents or residents are treating residents or general practitioners are treating residents or residents are treating general practitioners or any iteration thereof, I’m struggling constantly with my instincts to do the right thing.

There are other difficulties as well. Westerners are used to receiving policies and decisions from positions of leadership with fairly little fuss. If a manager comes up with a policy, a memo is sent out and that’s usually the end of it. Not so in this country. While this does seem to be generally accepted from federal decisions, local leaders simply cannot pull this off. Even for issues that seem trivial to me, it is expected that there should be plenty of time to allow for discussion, for each person to make their voice heard and, in general, for a consensus to be reached. It’s very difficult for me to get used to this and know how to function properly in it.

Additionally, Westerners are used to having a fairly crisp division between professional and personal issues. We can disagree on professional issues, and sometimes harshly, but still have no personal rift. This doesn’t seem to be the case here. It makes the waters much more treacherous for a direct, American style of leadership.

There are others but I’ll stop at that. So… please pray that I’ll be a good leader here. And what I mean by that is that I’ll honor God and bring glory to Him in my actions, words and attitudes.

Nathan says, "This thing is as big as my sister!"

Well, here is the large zucchini!  Much better looking than the pathetic bell pepper.  I forgot to get a picture of it next to Lydia before we grated it up for zucchini bread. But to keep it even here is a picture of little Lydia…

adorable outfit number 37 of 428...now those of you who know me, know i didn't actually number all of her outfits, but lets just say she has a ton...thanks to all of you who sent us to Africa in style!!

This is a bell pepper.  It used to be shiny, crisp and green…although still tiny.  For some reason bell peppers do not grow well over here.  I have not cooked with a bell pepper the whole time I have been here.   They are very very rare.  So I get too excited about what to do with it and it ends up going bad as I wait to determine the perfect meal.

I miss bell peppers and celery, but other than that our garden is amazing.  Stay tuned for a picture of a zucchini the size of my daughter and a pumpkin recipe in time for thanksgiving…(I want to test a different variation first).

It’s been a full week with lots of experiences and stretching. Two visiting consultants were with us for about a week working on strategic planning for the hospital. There were many good things that came out of their time here, including team-building among the Ethiopian staff. Lots of ideas and thoughts were collected and many interviews were conducted. In the end, we have a very logical game plan to approach the next five to ten years. That isn’t to say that we know what the details of the plan will be. But we have a handle on what the process will look like that will produce those details. Overall, it is an intimidating thing because of the magnitude of effort, planning and teaching that will need to take place to make it happen.

Management, especially done well, is a difficult process and I feel very out of place trying to do it. But God has put me here at this time in my life so I will proceed as best I can, trusting in His guidance and wisdom. If His strength can be seen in my weakness, I’m pleased to say I have a lot of opportunity to display His strength. Please pray for us as we try to move into a new level of quality in management and leadership.

I took Ol’ Blue for her first difficult ride this week. The chief administrator and I had to travel to Awasa this Thursday for hospital license business. It is about 200 km away and the first 70 km or so out of Soddo is a whipping. The bad news is the pavement is in really bad shape but the good news is most of it isn’t paved . It was educational, though, in that we discovered the suspension system in the truck needs some work. It’s always something, right?

Medically speaking, we’ve had more adventures with airways at the hospital. Dr. Asle Aarsland, an anesthesiologist, has been with us for a couple months now and I was thankful to have his help. In one day, we dealt with two children with breathing problems. The first was a five-year old boy who inhaled an unroasted coffee bean. In the operating room, Dr. Aarsland was able to pass a flexible scope into his windpipe (trachea) and see the bean stuck in the main airway going to the right lung. Since we don’t have any capacity to remove anything through our scope, we moved on to the standard technique. We hung him upside down by the ankles and proceeded to pound his chest and perform Heimlich-like maneuvers. After several episodes of this, the bean had finally moved into the main windpipe (trachea) and we were able to surgically perform a tracheotomy and pull the bean out. It’s always satisfying to drop the offending agent in a pan.

The other child has been more problematic. She is a three-year old girl who reportedly also inhaled some food. Our “Spidey-sense” was sending off warnings that something else was amiss so we went ahead with another scope. Our intuition was right and there was no obvious foreign body. However, she had very inflamed airways and puss. The inflammation also included the vocal cords and the larynx above them. My hunch is that she sucked down some scalding liquid but it’s hard to know for sure. She initially looked better with conservative therapy but started looking worse today. We repeated the scope and it looks about the same. Ultimately, the nurses were able to rig up a tent of blankets over the bed and a heater plate was used to boil water to humidify the air. A little more complicated than a humidifier, maybe, but it seemed to work because she’s resting comfortably now.

We would like to introduce the latest family member to join the Gray’s in Ethiopia. Last week, we finalized the purchase of a used Mitsubishi pick-up truck in Addis Ababa. It’s a studly, turbo diesel four-wheel drive. After getting everything checked out, it was time to put my new driver’s license to work and we made the inaugural drive down to Soddo. (OK, maybe it’s not that studly and, though it’s really nothing to write home about, we’re going to write home about it.)

Ah, so many things to communicate… Where do I start?

Let’s start with thanksgiving. God has provided this vehicle through the generosity of our supporters and we are extremely grateful to Him and to you. This is a huge answer to prayer. Though we have been thankful the available transportation via the hospital van, this is a much better option due to the flexibility and reliability it offers. It can often be difficult to work around the scheduling of the van and, especially with a family, it is nice to be able to get away every now and then. We have never felt in any danger here and have been thankful for the peaceful politics and culture of Ethiopia, but it is also nice to have reliable 4-wheel drive transportation should the need ever arise to leave Soddo. Thank you all so much.

Buying a vehicle in Addis

Sometimes you have to cast yourself completely on the mercy of another. Buying a used vehicle as a ferangi (foreigner) in Addis Ababa is one of those times. I was extremely blessed to have a knowledgeable guide for this amazing process. First of all, you need to forget the notion you may be used to, especially if you live in the US. When we sold Becca’s car in Texas, we met a guy beside the car. We signed the back of the deed and wrote the buyer’s name, who also signed the back of the deed. He gave us a money order… bam… done. We mailed in a form to make sure the authorities knew we had sold the car.

Not so here. There a countless unwritten rules and procedures. If you’re thinking, “Hey, what’s the big deal, just look it up online,” the Millennium Generation has a phrase for that: ROFL (stands for ‘roll on floor laughing’). To give just one example, it seems that you need black ink for filling in bank forms and blue ink for government forms.

After agreeing on the price, our mission agency wired the funds to our bank in Soddo. I got a certified check and we left for Addis. In Addis, our guide led us around like a blind man through a mine field. We visited around fifteen desks in three or four buildings, all in the perfect order. He would give commands and I complied. “Sign here.” I smiled, nodded my head and signed. “I need 100 birr.” I smiled, nodded my head and paid. “Give me your driver’s license and resident permit.” I smiled, nodded my head and handed over the documents. “Remember the document from three desks ago? I need that.” I smiled, nodded my head and complied. I was a helpless babe, but I was in good hands. I’m still amazed at how complicated the process was and how smoothly it actually went. The guy was fantastic. I can’t imagine how painful it would have been without him.

The whole process took about six hours but it was finally completed. The most surreal part involved the actual transfer of funds. Coming from the land of electronic money, I realize it’s difficult to imagine a place that functions so heavily on cash. But even after being here a year, I assumed that the sale of a vehicle couldn’t possibly involve any actual cash. Guess again. It seems that the certified check I had obtained could not be used to deposit directly into the seller’s account. Therefore about thirty pounds worth of bills that completely filled my backpack were delivered at the bank and were eventually transferred to, I kid you not, shopping bags for delivery to the seller’s bank. Amazing. Part of me wished it would have involved an aluminum brief case handcuffed to my wrist. Oh, well, maybe next time.

As we drove home, I kept imagining what it would be like for my family back in the States to be sitting in the car with me. The rules and norms here are definitely different. Basically, it doesn’t matter the circumstances, if you hit it, it’s your fault as the driver. Therefore, while driving, if you hit a cart, person, cow, donkey, goat, sheep, chicken or dog, it’s your fault. The upside is that drivers are generally fairly careful. The downside is that pedestrians are fearless. I’ve had to just chuck my usual American notion of what driving is like and get along with the local system. For the most part, as a motorized vehicle, I’m a guest on the road and I might as well relax and just wait on the twelve donkeys trotting down the center of the road. That’s how it is here. Thankfully everything went smoothly and we had an uneventful trip!

Well, should any of you come to visit us, you may be spending a little time in Ol’ Blue. I look forward to it!

we try and balance out the blog between hospital and home…we try and do the same with our time.  of course both often demand more than that.  good thing there are two of us to tackle it together!  don’t worry i will leave the surgery part to Paul.

speaking of time, when i was home this summer spending time with my mom and sister, i acquired a new nickname.  growing up i was “becca-boo”  and my sister was “jessie-bell”, but this summer i was reanmed FOTS.  I was known as the “Fun-Organizing-Time-Sucker”.  I think most of the tasks that my mother was accustomed to went out the window as I was always planning events…trips to the beach, to Sonic, to Moody gardens, to the mall, to see others.  And my sister and her husband were dragged into it too, even during there last few weeks before they left the country, i was encouraging them to join in FOTS activities….I loved it!  Hey, I was just glad I wasn’t renamed the “Time-Organizing-Fun-Sucker”!

Some of the FOTS activities my dad got sucked into was cooking for the many family and friends who were visiting and taking pictures….here are a few of the pics.i feel like this picture shows their personalities already.  nathan with his silly, independent nature and loud Hawaiian shirt.   lydia raising her hand saying “pick me” and decked out in her fancy clothes.  she is already such a social butterfly.  she will start to whine a tiny bit and we will just talk to her and she quiets down.  or nathan will sing her a song, he will sing “baby-ah, baby-ah, baby-ah” instead of baby lydia he combines the two words into baby-ah!

i love this “action-shot” because it shows how much fun nathan had with his daddy this summer.  what a special time to have him home for 2 months.

the latest family shot

and sweet baby lydia