“God said yes, mommy!!! Did you hear him? He said yes!”

So what would any mother who lived in Ethiopia do?…defrost the freezer and give the boy some snow to play with.

He played outside with the “snow” all afternoon.

Paul’s mom and stepdad were able to come and visit for Christmas and Nathan’s birthday.  We had a great time and the kids loved having grandparents around and Paul and I loved being able to show them what life is like over here and all of the chocolate they brought.

Paul's mom, Shelly with 2 spoiled grandkids

The snickers the size of my forearm! We also had the reeses cup the size of my fist X 2!

While Paul’s family was here, JD and I took a trip with some others here to the double waterfall in the Wolaitta region.  I had never been to see it, but many visitors come and go to see the falls.  I was glad I went, it was very beautiful.  I didn’t hike all the way down this time, but next time.

Ajora falls

JD and I at the top of the waterfalls

What a few of us did while the others hiked all the way down. You can't hear it, but we are also listening to a very random mix of old school music including Ace of Base.

After the hike we went to one of the guys house who grew up next to the falls in a small village.  He brought sugar from Soddo and they served us coffee with roasted barley and peas.  In the rural villages, they often drink coffee with salt because it is so much cheaper than sugar.  Of course, they treated us with more than they had, with many bananas, snacks and coffee.

JD in the seat of honor, since he was the oldest one there and Ermias, the guy's whose house we were at, was his guide down the falls.

The whole family

We had a great Christmas day with cinnamon rolls, fellowship, church service, talking about Jesus’ birthday with the kids, and a nice meal together. Of course, I forgot to get our annual Christmas day picture together before Paul had to go to the O.R. and the kids went to bed.

Our Christmas tree with paper lights

The kids opening their stockings...i think it was still dark out.

Nathan turned 4! It is amazing how much he has grown up since he turned 4.  I feel like some things are clicking and he understands how to make things easier for all of us.  The other day he said, “Momma, if I talk nicely and say please then I don’t cry!  Like this, see.”  And he has been doing a good job asking nicely and talking to Lydia in a sweet voice, instead of yelling and getting frustrated.

The big boy and his new car

We had a little birthday party for him at a local café.  I had them serve fresh mango juice and French fries, and I brought cup cakes and popcorn.

New Years came…and went without a picture.  But we got together with the expatriates in the area (Ethiopia celebrates their new year in September).  We had a lot of fun.  Everyone brought finger foods and we had a fire and made s’mores .  And then we played Wii bowling and Tiger Woods golf.  We also had a white elephant gift exchange.  It is always fun to hang out with people who usually work together at a fun party where you don’t talk about work.

And then we had another Christmas…Ethipoian Christmas was the first week of January.  We had planned to take off that weekend and visit with friends.  We took a 2 hour drive with the kids and got to Hawassa.  This is a newer town in Ethipoia with a large university, so overall the infrastructure is much different than Soddo.  It has also become the latest place where new resorts are popping up, so there are nice restaraunts, swimming pools and fresh fish from the lake. There is a Norwegian guest house that is right on the lake that we went to.  It is really the perfect vacation place for us.  We have a small little cabin with 2 bedrooms and a kitchen.  There is a nice playground and a kids pool that we frequented daily.  We ate dinner with some friends who were there with us and another family that lives in Hawassa.  The first night we ate doro wat that Etagainu made before we left.  The traditional meal for  Ethiopian Christmas is doro wat, the famous, very spicy, chicken stew.  The next night we grilled hamburgers and ate outside while the kids played.

How many onions does it take to cook 2 chickens?...10 pounds! In order to cook traditional doro wat, it takes 5 or 6 pounds of onions per chicken! Wow! Thankfully the onions cook down first for a long time and then you add the chicken for another long time.

On our way out of Hawassa, we were priveldged to get to go and see the Heli mission compound.  The helicopter lands in Soddo every so often to bring patients or to pick up evangelists.  I had the met the pilot several times before and he offered to give Nathan a tour of the helicopter.  Nathan brought along his helicopter that he got for Christmas and asked the pilot if his helicopter had wheels too.

Meeting the pilot on the helicopter pad

Lydia flying Nathan around.

Then we went to Addis to pick up a team that was coming down to Soddo.  While there we got to spend some good time with Jeremy and Christina Gabrysch who had just arrived in Addis for language school.  It was a blessing to be able to encourage them and take them out to eat and to do some shopping while they try and adjust and get acclimated.

We also booked our tickets to America.  Which we are excited about!  We will come home in late march, spend most of April, May and June in Dallas and Travel the eastern half of the country in July, and end in Houston with my sister and family.

After that we came back to Soddo with a team from Loma Linda Universtiy.  Paul gave them a full tour of the hospital and the residency program.  I helped provide meals and take care of logistics and they got on a plane early this morning to head to west Africa…and that brings us to today.

A quiet Saturday where we had Bible study with the residents and wives this morning, had a picnic lunch with the kids, rest/quiet time after lunch and catching up on emails, blogs, and prayer letters now.

So that is the last 6 weeks!  We hope all of your holidays have great

It all started at 1:50am Saturday morning, is that even called morning? I got a phone call from Stephanie all she said was, “Mommy, said he will be here in 20 minutes.”  Okay, I better get dressed and ready.  Wait, what? Who’s mommy?  Why is she a he?  Mommy is one of the local guys who drives to Addis every morning.  He leaves between 2am and 3 am every day to drive to Addis in the dark before all of the people and donkeys and cows wake up to get on the road.  I had planned out a trip to go to Addis and surprise Paul at the airport on his way back from Zambia.  Some of our friends from Soddo, were going to stay at our house with the kids.  They have one 5 year old girl, so the kids were excited for a sleep over.  And Nathan and Lydie knew that I was going to Addis to get daddy, so everyone was excited and ready for the surprise plan!

So, Steph and I get in the van, thankfully they let us sit in the front with the driver, because there 18 other people in the back of something like the size of your mini vans.  I admit, I was a little freaked out about a dark drive on African roads.  And since, I told multiple people to pray for me, I got a total of 3 calls the next day confirming that I was alive.  Mommy played a fun mix of English and Amharic songs while switching his gum every so often.  The guy behind him sang along to all the songs, including some random version of a Michael Jackson song.  At one point he yelled out, “play Shikira, Shikira, Shikira”  The driver only answered back with, “Beyonce is better”.  The moon was full that night, so the whole country side was lit up.  The drying wheat on the mountain sides reflected the moon light resembling snow. And we saw several packs of hyenas crossing the road as we came upon them.

We arrived at Addis at 6:30 am and headed to none other than the Sheraton for a day of laying by the pool, since Paul didn’t fly in until 8pm.  We asked the Sheraton conceriege what time the pool opened. He said, “Pool???”  Wondering why in the world we would want to go to the pool at this time of day when it is still 60 degrees outside, but we knew the sun would come out. We had an amazing breakfast there and then laid out by the pool from 10am until 3pm.  What a relaxing day.  I saw some of my friends and found out she had come to Addis to surprise her husband as he came in from Uganda…how funny that we had the same idea.

After I got to the airport, I only waited about 30 min when I saw Paul waiting for his bag.  I had to wait on the other side of these huge glass windows, so I texted him.  I said, “You look really handsome right now in that blue striped polo.”  I saw him from a distance messing with his phone and as soon as put in his Ethiopian SIM card a message popped up.  He thought, “How old is this message, when did she send me this?…Wait a second, I am wearing a blue polo right now!”  And then he looked through the windows and saw me.  He was very surprised and excited that we could spend some time together before heading back to work and home.  We had a great ride home together, where we brainstormed about what is happening and what is to come…you know, we basically solved the problems of the world, together.

So that was my really, fun surprise.  It was an adventure for sure. And I would do it again for him any day.

Us in the car heading back to Soddo. It looks a lot like a picture we took 8 years ago, when I surprised him and met him in New Mexico, so he didn't have to drive back by himself....wait here it is...we don't look a day older. right?

Here is a link to the blog about how we first met and when this pic was taken.  It’s a good story.

Last week was the annual general meeting of the Surgical Society of Ethiopia (SSE). It was a significant milestone for PAACS and God blessed us with encouraging evidence of how far He has brought us. Three years ago PAACS leadership put the Soddo program on probation because of significant educational problems. The residents weren’t operating enough. They were failing examinations. There were big problems. The PAACS team attended the SSE meeting in 2008 and the reception was anything but warm. It was before my arrival, so I only have second-hand testimony. But the PAACS residents at that time were openly told that they were fools for training with PAACS; that their training would be worthless. Reportedly one of the main topics of the meeting was the shortage of surgeons in Ethiopia and the need to address this issue. Despite this need, PAACS was viewed with derision.

Three years later, much has changed. The program is no longer on probation and, from an internal standpoint, is doing much better. The residents are performing an adequate number of operations. Last year, all Soddo PAACS residents passed their yearly PAACS exam. Externally, we have been granted accreditation by the Ministry of Education as a general surgery training institution. We have been accepted by the Ministry of Health and our graduates are being granted licenses as surgical specialists. New surgeons have joined the teaching staff and more are on the way. The College of Surgeons of East, Central, and Southern Africa (COSECSA) has granted us three years’ accreditation for general surgery training. We are establishing a partnership with Myungsung Christian Medical Center in Addis Ababa to double the size of the training program. God has done some wonderful things.

We have been openly invited by the SSE to contribute presentations to their scientific conference. This year, the PAACS program at Soddo contributed five of the twenty presentations at the conference. Duane Anderson, orthopedic surgery, gave a presentation on a method of treating chronic shoulder dislocations in the absence of available shoulder replacement prostheses. Segni Bekele, surgery resident, presented a case series on the treatment of complex pelvic fractures in the absence of portable x-ray in the operating room. Tewodros Tamiru, surgery resident, spoke about a case series describing a successful method of managing pediatric airway foreign body aspirations in the absence of available rigid bronchoscopy. (We are becoming adept at doing things without the standard equipment!) Tewodros’ presentation generated the liveliest discussion by far of the conference! He gave a smooth and polished talk and handled himself superbly during the question-answer time. Jonathan Pollock, general surgery, presented data about the hospital’s experience with the management of acute abdomens in the last three years. He tied this into the main theme of the conference, the training of health officers in emergency surgery. In particular, he commented not only on the need for increased access to surgical care but the complexity of cases that present with surgical emergencies. And Paul Gray, general surgery, presented data from a trauma registry that has been established at the hospital. Though I’m biased, I think PAACS made a strong showing at the meeting. For the first time at SSE meetings, an award was given for the best presentation. Jonathan’s presentation received the award.

Perhaps a more profound testimony to PAACS’ improvements, though, was found in personal discussions held throughout the conference. Though there are still some sideways glances at the mention of PAACS (we are something completely new, after all), there seems to be a much increased acceptance. Many of the surgeons spoke positively to us. Additionally, in the midst of a lively debate about whether or not it is a good idea to train non-physician health officers to perform emergency surgery, we received several comments that our model of training in the rural community setting is a good option to meet the surgical needs of the country. Again, God has brought us a long way.

However the highlight of our time in Addis, by far and away, occurred after the conference was over. The two PAACS graduates who are practicing in Ethiopia were present for the conference. Solomon Endrias graduated in December, 2009, and Haileyesus Tesfaye graduated in December, 2010. We wanted to hold a “PAACS Alumni” dinner and the graduates and residents were asked to pick a venue. So one the evening after the last day of the conference, we gathered at the roof-top restaurant of the Webe Shebelle Hotel. It is a famous hotel in Ethiopia and the restaurant had the quiet and distinguished feel of a city icon. Present were Solomon and Haile, the current PAACS residents, Duane and his wife, Jackie, Jonathan and me. My greatest sorrow is that my wife could not be there. She is every bit as much a part of this as I am.

That night was beautiful. Life here has not been easy and it has often felt like a long, tough journey in the desert. But in that get-together, God gave us an unexpected and delightful evening at a cool, lush oasis. We listened as Solomon and Haile described their practices and related stories of their work since leaving PAACS. Both of them had a joyous and quiet confidence that was striking. I couldn’t help but marvel at the conversation. In many ways, they spoke mainly to the current PAACS residents, especially Tewodros, who will graduate next July. They encouraged the guys, reassuring them of the quality of their training. They spurred them on with stories and admonition of hard work. And they inspired them with stories of how God was working in their lives and practices. I marveled because I remember some the history. I remember sitting down with each of them at one point when they poured out their heart and discouragement and plans to quit PAACS. Each of them had decided that it was too much, that it wasn’t worth it, and that they would just get a job somewhere as a general practitioner. They could still offer surgical services with the training they had already received, but they were ready to move on. But God brought them both through to completion, and the difference now was so palpable! Both are strong, confident licensed surgeons who are making a profound impact in their respective places of practice. Both men are exhibiting a loving, dedicated care for their patients that is so striking because it is so rare. Both are highly valued at their hospitals and in their communities.

My heart was warm as I listened to the graduates and residents chat. And I worshipped God for what He has done. At one time, this whole project seemed quite tenuous and insubstantial. But at that dinner it was evident that something real had developed. Men were in training and men were finished, with stories to tell. There was a sense of belonging to something, a spirit of PAACS and a pride for being there. But at a more foundational level, there was sense of brotherhood and fellowship in the service of our Lord Jesus. The stories weren’t about personal conquest or achievement. They were about the amazing things God had done. The reality is we were gathered at the table of fellowship sharing stories and boasts of our God’s greatness. Though the night definitely felt like an oasis, I think the more accurate picture is that it was a preview of the Day we will gather at the banquet table of our Lord, when He will once again break bread and share wine with us. I can’t wait to hear the stories on that day! How wondrous our God is and how great are His achievements!

But we are not there yet and there is more work to do. So we’re back in Soddo and back at it. I wanted to share this with you in the hopes that it will be an encouragement. Thank you all for your love, prayers and support. God is very, very good.

On the night of the dinner, I jotted down some notes so as to not forget what Solomon and Haile told us. I’ve added them below.

—-

Solomon

Solomon was previously the lone surgeon at the Otona Hospital in Soddo, a government hospital. He worked there for about a year and a half after his graduation from PAACS. He was recently offered a position in Hawassa, the head of this region, and he moved there with his family in August of this year, despite the pleas of his hospital and community in Soddo. He is the lone surgeon at a small government hospital in Hawassa. The hospital is new and was recently upgraded from a health station with the intent of serving the local population of Hawassa. The Hawassa Regional Referral Hospital exists on the outskirts of town to serve as a regional tertiary hospital. Solomon’s new hospital has two operating rooms and forty beds, of which twelve are allocated to surgery. When he arrived, there were no supplies for performing operations and he spent his first month building a functional operating room, after which he started performing emergency operations. In the intervening months, he has become progressively busier and the people are starting to come to him preferentially as the hospital is gaining a reputation where there are good patient-doctor relationships. His OR is now reasonably well stocked, but he had several elective cholecystectomies on hold because he didn’t have an adequate retractor. SCH donated some Diever retractors and he has now completed those operations and is actively using the retractors.

As of right now, he is operating at his hospital three days a week and is spending two days a week at the Hawassa Regional Referral Hospital. He reports that the hospital is in bad shape and that surgical patients are not receiving good care. There is a large backlog of general surgery cases (which he is now whittling down). Additionally the orthopedic care is significantly lacking. There is no orthopedic surgeon and these patients are being managed by the medical service. However appropriate care is not being given. Fractures are being inappropriately casted by internists. Inappropriate wound care is being done, including simple external dressings for osteomyelitis and open fractures. Apparently there used to be an orthopedic surgeon there, but he was also working at a private hospital in town. He was noted by the hospital to be deficient in his duties; inappropriately canceling cases, not showing up for clinics, not rounding on patients, etc. It seems he was offering the patients more timely and efficient care if they would transfer to the private hospital (and pay the private hospital rates). He and another surgeon carrying out similar practices were fired from the government hospital. Solomon is now tackling these cases. Solomon reports that another example of such forced shunting of patients into the private sector includes operations for neural tube defects (including myelomeningoceles). Solomon offered to operate on these patients at the Hawassa Referral Hospital and faced opposition for doing so from the surgeons who were financially benefitting from their activities. However he did it anyway and has successfully treated several patients despite the opposition. He is actively involved in teaching at the Hawassa medical school; to medical students and house officers.

He particularly commented on the sad situation where patients are being transferred to this referral hospital from far away, but they are not receiving appropriate care. In particular, he noted patients being transferred from two areas: Shashemane and Bale. This is interesting because our next PAACS resident scheduled to graduate (Tewodros) is planning to go to a hospital in Bale, in a city called Goba. The next PAACS resident scheduled to graduate after Tewodros is Daniel, and he plans to work in Shashamene! Solomon encouraged both of them as to the very definite need in their respective areas and fruitful possibilities for meeting those needs.

We asked him if there are any other particular areas of difficulties that we might be able to help with. He mentioned that he doesn’t have any legitimate chest tubes, so we will get a handful of chest tubes up to him. He also expressed a desire to work on some research for presentation at the Ethiopian meetings and requested assistance with this. We also agreed to work with him on this, as he directs.

Haileyesus

Haile is working at a new government hospital at Gimbi in west Ethiopia. Similar to Solomon, the OR facilities needed building after his arrival. But he has a supportive administrator and has been able to set up a functional OR. His initial routine included operating five days a week with daily surgical clinics. However he fairly quickly recognized this as unsustainable and has now shifted to operating on Mondays, Wednesdays, and Fridays. He holds surgery clinics on Tuesdays and Thursdays. When asked about emergencies, he says he has them most nights. However his clinical duties have not eliminated his efforts to serve Christ in his career. He describes how he was faced with the question of prayer before surgery with his first operation at the new hospital. He was called by the gynecologist working at his hospital about a pregnant patient with appendicitis. Haile was the only professing Christian in the operating room and he debated internally about praying before the operation. Finally he announced to the room that the routine in his training was to pray for each patient before operating. Therefore he was going to pray. He said a loud and firm prayer and, as he put it, the room was silent well after the prayer ended! But in his heart, he felt his fear and intimidation at his first operation fade into Christ’s peace. The operation went well. The entire hospital is now well acquainted with his practice of praying before surgery and it has become accepted and expected. His anesthesia team keeps the patients awake until prayer is finished. Haile told one story where he was about to operate on an emergency patient and asked for the knife. His assisting nurse, not a Christian, reminded him that he had not prayed yet! Indeed patients are coming in from the community with the expectation that Haile will pray over them before surgery.

But his service to the Lord does not end with prayer in the operating room. He says he is busy enough that there is little time for “preaching” on rounds (sharing the gospel). But he continues to pray on rounds. He is using his clinic time to specifically share the gospel. He related one story where he treated an older man with a stab injury to the chest. The man was an alcoholic and was in the habit of beating his wife. The wife has a grown son from a previous marriage and, on one incident, stabbed the man in the chest for attacking his mother. Haile treated him with a chest tube (he also doesn’t have chest tubes – something we intend to remedy immediately). Haile shared the gospel with him during his hospitalization. In follow up clinic, the man accepted Christ as his savior and repented of his sin. The wife was present and began speaking badly about the man, skeptical that he would change. Haile encouraged her that his heart was changed and that Jesus could change his behavior. He also encouraged her to believe in Christ for her own salvation. However she was reluctant and preferred time to think it over. Haile and a Christian general practitioner who has been working with him (and, incidentally, has applied to join PAACS next year…) traveled out to their home one weekend to follow up. Haile says it was a very poor home and they were surprised to see them visit. They encouraged her of her need to follow Christ and encouraged the man in his new faith. The wife was convicted and accepted Christ in her house. The son was no longer living in the home, for fear of the step-father he had stabbed. Haile and Surafel encouraged the man to drop any legal action against the step-son and seek reconciliation. He had been forgiven by Christ and he should forgive as well. Over the course of a three to four hour visit, the son was returned to the home and reconciliation had taken place. Furthermore, the entire family had placed their faith in Christ for salvation and life!

Haile has been working in coordination with the local church. He is referring people who become believers to the church for discipleship and fellowship.

One challenge Haile faced early on in his surgical practice was the need for a productive partnership with anesthesia. Thankfully most of the nursing staff was young and new, as it was a new hospital. Therefore they were pliable and eager as Haile set a high standard of care, especially relative to the usual setting in government hospitals. He feels the quality of care in the wards is now quite good. However he initially faced strong opposition from his anesthetist. The man was an experienced anesthetist and used to working at his own pace of life… and resistant to Haile’s desire to get work done. The man was also an alcoholic. Haile relates there were several heated discussions, including the ultimatum that one of them would have to leave. He eventually received the support of the administration to be named the head of surgery and this improved the situation. But the final solution ultimately came when, through Haile’s witness, the man accepted Christ as his savior and gave up alcohol! Additionally another anesthetist was hired, also a Christian, and they have a good team at this point.

Haile repeatedly expressed his thankfulness for his training with PAACS. He feels well trained and is confident about his surgical work. He is also thankful for the spiritual lessons he learned in PAACS and for the ministry he now owns because of his training. He felt a burden to make sure that the other residents knew this and that the PAACS faculty knew it as well.

Here is our latest newsletter, if you didn’t receive it by mail you can view it below by clicking on the picture.  If you would like to receive our Christmas card, email us your mailing address before Monday!  We would love to send you one.

Other than planning our Thanksgiving meal, the most exciting is the building of several new houses on the compound.  For over a year, we have been talking about families wanting to come, but there was no housing for them.  So Paul challenged them, “We want you here and need you here, can you find a way to build the needed housing?”  And they did.  They partnered with an organization called MSAADA.  Who designed their houses and has now sent an architect to oversee the building of their houses.

Zeleke on the left, our local contractor and Jeff, the architect with MSAADA that will be here for 9 months. Behind them is the shed behind our house and our house is to the right.

Flattening the land to begin the foundation...yes, all done by hand. It may take longer, but it is giving a good amount of people a job.

Here is my family.  It was so fun to all be together, it had been over 2 years… since before Lydia was born.  We had so much fun together and I feel honored that they would travel to Ethiopia to see us.  The highlights of their trip were:

• seeing Nathan and Lydia, love having ZsoZso, Granpa and Aunt Sica around
• playing banana grams
• making ZsoZso bags with fabric from here at a little sewing shop (ZsoZso bags: coming to a store near you)
• thinking of creative ways to eat Ethiopian wat without injera
• Granpa teaching Lydia how a spider barks and how crocodiles eat
• Nathan and Lydie dancing at our meal at the hospital kitchen and the workers joining in
• Nathan and Lydie dancing any time of day
• Swimming at the sheraton in addis
• Ice cream sandwhiches
• Real half and half in the coffee
• Sister time
• Trip to Arba Minch on public buses
• Mom teaching one of my workers how to make RedBeans and Rice and Chili
• long hike up the mountain 1 and 1/2 times
• catching up on what is going on

Our community here in Soddo was so loving and supportive. God has really blessed us in putting us in community with these people. The care and medical advice of Ruth Droppers, the loving prayers of the Karnes’, Jon Pollock (our brand newly arrived surgeon) completely taking it on the chin for me and the loving prayers and support of his wife (equally brand new to Ethiopia); all of it was beautiful. Jon held down the fort admirably. He seems to have had a few ‘coming of age’ cases, but he handled them like a pro. And Asle, our Norwegian anesthesiologist, was amazing. He gave such selfless and tender care to me and my family during this time. One of the greatest physical blessings he gave was being present during a lumbar puncture. After I had received a few unsuccessful attempts with a rather large bore needle, and electrifying agony down my right leg, Asle gently asked if he should give it a try. His aim was blissfully true and he allowed the successful completion of a procedure for which I was about to throw in the towel. But even more profound was the love, wisdom and encouragement he shared. Honestly, at the time of our transition to Addis, my limited insight never considered the possibility I might need transfer out of the country. Asle really helped me work through that limited insight. He helped teach me about what it is to be a patient and yield to the authority and expertise of other people. I don’t know how much of it came from my being a doctor or just being me, but I had a few moments of being a lousy patient. But I think Asle helped me to improve. But the thing I’ll probably remember most was the encouragement he gave me a few hours before I got on the plane for South Africa. I was physically and emotionally worn out. I was forced to stare at my own physical frailty. And in the midst of all this my precious wife was stuck with handling all the logistics of our family and how to get to South Africa; and there was nothing I could do to help. He pulled up next to the bed and reminded me of Jesus’ words in the Bible where he told the disciples that all power had been given to him. My savior, who loved me and was watching over me, had all power. He encouraged me to rest in that knowledge and he prayed with me. Again, God really has put us with some great people.

But it wasn’t just here. It was the larger community of faith to which we belong. I am so touched by how many people have been praying for me. The emails and words of encouragement were beautiful. I wish I could adequately express thanks, but I really don’t know how. God provided beautifully for us in the family of Chris and Miriam Forget in South Africa. It’s just like God to arrange it so that the daughter of our obstetrician/gynecologist here in Soddo lives twenty minutes away from the hospital I was transferred to. They were so loving and accommodating during our time. I am deeply appreciative of them. Also, I have a college friend named Andrew Arp who is now a children’s pastor in the US. While in the hospital in Johannesburg, I was visited by a young mother carrying a care package. She told us she knew Andrew Arp and that Andrew had gotten in touch with her about our situation. She had come to tangibly express the love of Christ. Additionally, after I had been discharged from the hospital, I received a phone call from another pastor in the Johannesburg area who also knew Andrew. He too gave more expressions of love and offers of help. As Becca mentioned, through contacts with one of the families joining us in Soddo in the next year, a kind and godly man named Karel visited us in the hospital and even provided us with a phone during our stay in South Africa. Karel had spent many years serving the Lord in Africa and he added to his ministries with us.

I could truly go on and on. Our mission agency has been awesome. The people of PAACS have been awesome. And the care and service we received from our insurance and evacuation companies were first rate. As I was being strapped into the plane from Addis Ababa to Nairobi, I was deeply struck by how blessed I was. I had already received the best care available in the entire country of Ethiopia. This was a service that most of a country of maybe 90 million people would never have access to. Not only had I received that, but I was being sent at great price to receive even more. Who am I to deserve that? Am I special because I happened to be born in the United States? What makes me different than those other 89 million people? It reminds me of one of the things I’ve been praying for: poverty of spirit. I can honestly say that there is nothing in me that is inherently deserving of these blessings. I can’t give a compelling explanation for it beyond the fact that God has been so kind to me and my family. And it drives me to gratitude. I am so thankful for God’s kindnesses. Outside of his gracious goodness, I don’t know why he has done it, but I am deeply thankful for it.

So what have I been learning from all this? I may never be able to fully answer that, but the sense I’m getting is one of quietness; quietness and trust in the face of an almighty, sovereign God. I am fully convinced that God is the ultimate source of everything that has happened, including my getting ill, all the moving to and fro, and our return to Soddo. God put me on my back with an illness that, in the end, we couldn’t identify. God took care of my family and me throughout it all. And, at least for now, God has made me better.

In saying this, I am not in any way diminishing the reality of a spiritual struggle. Satan is real and there really are dark spiritual forces who would seek to harm and destroy. Indeed, I was reminded by Jim Brown; previously the PAACS program director at Ngoundere, Cameroon, and currently helping to lead the PAACS program at Mbingo, Cameroon; that in the last couple of years at least four PAACS instructors have been laid low with weird and mysterious medical problems. There undoubtedly is an element of spiritual struggle going on. But God is sovereign over even the activities of evil beings. There may have been some that meant this last month for ill and for harm. But God’s word assures me that for those who love him and are called according to his purpose, God causes all things to work for their good, to conform them to the image of Jesus. This has given me great comfort in these last weeks.

What is interesting is that my grasp of this reality isn’t a new thing. God has been walking me through this truth of his sovereignty for several years now. Rather, this illness experience has been a time where this beautiful truth of God has been taken off the pages and out of the books and into flesh-and-blood experience. God took us on a field trip and the lesson has a deeper meaning than before.

But I want to focus on the idea of quietness, particularly in contrast to the sovereign goodness of God. One thing I need to be very careful to articulate is that I am not, and never have been, some saintly sort of person who glides through life with his hands folded serenely in faith, eyes glistening with love as he gazes heavenward, and a perpetual smile of joy gracing his face. I’m a missionary who struggles not to cuss while muttering to myself while stomping from the hospital to my house. I have tried in the past to convey that it has really been a struggle to submit my pride and ego to the Lord as I’ve lived and worked in Ethiopia. The surgical staff at the county hospital of my surgical residency host a graduation dinner each year. At my graduating class’s dinner, after working five years at the hospital, I discovered that one of the defining characteristics they pegged me with was that I was generally angry at that hospital and that I considered it a ball-and-chain around my ankle. Ouch. Very humbling moment for a guy who was slated to go to the mission field. And, indeed, the same internal struggles that produced that assessment have been active during my time here. I am a broken pot. And no matter how badly I wish I could do it, I can’t glue the pieces together. I don’t in any way consider these last few weeks as a divine kick-in-the-pants wake up call to the reality of these struggles. By God’s grace, I’ve been seeking his lordship and wisdom in these areas for years, and even more intensely in the last few months.

But I do think God is using this time to speak in a very tangible way about the nature of the life he has called me into. I think the message I’m hearing is, “Be quiet, Paul. Be still. You talk too much and you’re too busy. I will accomplish my will. Wait for me and trust me.” He brought me low with something we couldn’t even diagnose, much less fix. And then he brought me back. It was all of the Lord. (I realize that on a scale of suffering, this really was just a splash in the shallow end. But it was still a strong reminder of my frailty.) Becca and I have been reading through a Bible reading plan and, as it happens, one of the books scheduled for September is Isaiah. Though I got rather behind during my time in hospitals, I was able to catch up during my week in South Africa after discharge. What strikes me about Isaiah is how blatantly unilateral it is regarding God’s interaction with the world. The book has nothing but judgment and condemnation for humanity. It doesn’t matter if it it’s talking about Israel or any other nation. There’s nothing redeeming or good to be found. And, as unflinching as it is in that regard, it hammers home again and again the greatness and incomparability of God; man’s faithlessness again and again compared to God’s infinite worthiness. But in spite of this vast contrast, the book of Isaiah repeatedly announces God’s intention to bring mercy and healing; to fix the problem. And it is completely unilateral. God is going to do it. God will accomplish it. There is no hint of partnership or division of roles.

In the struggle of trying to follow God, it is good to be reminded that this is God’s show. He started it and he will finish it. One particular line in Isaiah really impressed itself upon me. It is from Isaiah 30:15:

“For thus the Lord God, the Holy One of Israel, has said, ‘In repentance and rest you will be saved, in quietness and trust is your strength.’”

I really don’t have any profound revelations. But I have a strong sense of God’s gracious love for me and my family. And I am newly reminded of my smallness compared to his greatness. There seems to be a new sense of quietness and rest in my heart and I pray that God would lead me deeper into that.

I will start from the beginning, on Saturday, August 27^th, after our Bible studies Paul said, “I kind of feel like I am getting sick.”  I wrote it off and he went to bed early with his first fever that would last almost 2 weeks.  He stayed in bed through Tuesday, with the exception of doing a case on Sunday.  He would feel better between fevers and started taking malaria meds on Monday (just in case) despite a negative blood test.  Early Wednesday morning, his fevers and rigors got worse and he got the worst headache of his life (that lasted over 24 hours).  Dr. Ruth saw him again and then Dr. Asle came by and they both decided he probably needed to be taken to Addis to receive more testing.

One of the biggest thank you’s goes to Dr. Asle Aarsland, he was key to our survival from this point until we got on the plane to South Africa.  We never thought we would move to Ethiopia and fall in love with Norwegians, but it happened.  There is a large Norwegian presence and the more and more we learn about their country and culture, the more we are impressed with their compassion and self-giving attitudes and Asle and Kari, must be at the top of that selfless pyramid.  Asle graciously drove us to Addis, thinking he would get us settled in at the hospital up there and come back to Soddo. Well, let’s just say I never settled and was slightly freaked out the entire time, so he stayed. We were admitted to the best private hospital in Addis on Wednesday night.  The rest of the story in Addis goes…fever, medicine, IV, IV blown, new IV, test negative, fever, medicine, IV blown, new IV, fever, medicine, tests still negative, and repeat.  Until Sunday morning after the doctors heard that Paul nearly fainted in the middle of the night and he was still having high fevers, despite antibiotics, malaria meds and Tylenol, they decided we should probably transfer out.

At which point I called our insurance company from skype and immediately was referred to the company who has the experts in medical evacuation, International SOS.  They were so helpful, it also helped being at a hospital and with a doctor who was used to shipping people off by air ambulance for a higher level of care.  This day was very hard for us, but in the midst of it I was most thankful for…A travel agent here in Addis who on his Sunday afternoon, booked me tickets, went to the ticket office and emailed me with the e tickets before 4pm.  Angie and Sophie, who packed up the kids bags, organized a ride to Addis and dealt with 2 car sick kids in the 5 hour car ride where as Nathan put it, “the driver kept going fast then slow, fast then slow…” Sophie, who also packed for herself to go on a mystery journey with 2 kids and an anxious mother.  A Norwegian surgeon, who helped Paul get transferred and then went with him in the ambulance to the airport and then proceeded to bring all kinds of yummy desserts to our guest house after all of that. For Tabby, a good friend who also lives here in Ethiopia and for her sweet and divine phone call to me. For Paul, who I got to kiss as he left on the ambulance.  And again, Asle for keeping me sane, by reassuring me and praying for Paul before he left.

After getting back to the guest house, I received several calls from International SOS, stating every step in Paul’s journey.  It was in the middle of the night for me, but I was still very thankful every time Fernando from Philly called me and told me that Paul had made it to Nairobi and then to South Africa and then to the hospital.

The next day, Sophie, the kids and me all made it through an uneventful flight and a train ride in South Africa.  But I am telling you, if you ever need someone to travel with you and small children around the world, I wouldn’t want anyone else, but Sophie to do it with me.  She is the best.  It helps that she knows the kids really well and is really great at interacting with them and keeping them entertained.  This big thank you goes to her!  Thank you, Sophie.

After getting off of the train (which Nathan was thoroughly disappointed that the train didn’t have smoke and coals like Thomas the Train, oh well)…we were met by Miriam, the daughter of Dr. Mark and Allison Karnes, who live here in Soddo with us.  She and her husband, Chris, offered their home for us to stay in.  Of course, we had no idea how long we would actually be there, so it was very generous of them to let us stay with them in their home.  The first thing Miriam said to Nathan was, “Nathan, my house has a lot of toys, do you think you could help me by playing with them?”  Well, Nathan was sold, he took her hand and didn’t look back.  They had 2 sweet little children and a fun trampoline and sand box, what a blessing to be able to stay in their home.  As Sophie said at one point, “I didn’t know what I was going to do with 2 kids in a hotel room for a week?!?”  Yeah, that would not have been ideal.  How God’s provision is amazing, he not only provided a comfortable home, but a loving family to be with us during this time as well.

After meeting up with Miriam, she drove me to the hospital, so I could see Paul. I got out and nervously went to the front desk to ask what room he was in.  They said he was in the Orchid ward (which to me sounded very Sci Fi, too much Lost, and didn’t sound like a flower at all at the moment)…so I headed in that direction and immediately saw the sign that said, “General ICU” (commence freak out)…and then I saw the sign that said Orchid ward (sigh of relief).  When I went in Paul was resting comfortably and it was so good to see him. He was off all the medications except IV paracetamol (Tylenol) and already felt better just being off of the anti-malaria meds.  He said, the doctor said, she didn’t know what she was treating so she was going to back off on the meds, until the test results came back.

I left the hospital that night and came back to the house to clean/sleeping children (again thanks to Sophie) and a hot meal brought by a family in their church.  I couldn’t believe it when they told me that some families in their small group offered to bring meals while we were there.  Amazing.  I was so humbled by that, and here is why… There have been many times, since moving to Ethiopia, that we have had sick or suffering friends.  I always wish that I could be there to help them tangibly, whether it is bring meals, or watch kids, or give hugs at the hospital.  I know from here I can pray and send words of encouragement and I always make myself rest in the fact that others are doing the tangible things.  And then the roles reversed…Paul was in the hospital and I was in a foreign country, and people I didn’t even know were feeding us and housing us.  The body of Christ is amazing.  All around the world the church is living and acting out in compassion and obeying the command to love one another.  Not only this, but we had several friends who contacted friends of theirs, who happened to be in Johannesburg, who wanted to help.  Several people visited us in the hospital; one person brought us a phone with minutes on it! And another person brought an entire box of snacks and fruit and goodies.  It was humbling to feel so loved by people near and far.

That brings me to another big thank you.  Thanks to all of you.  Thank you, for your prayers, for your emails and words of encouragement.  Thanks, for passing along our story to others who could pray too.  Thanks for praying together.  It was so encouraging and uplifting to read each and every word sent by all of you.  And we believe God answers prayers and he has answered our prayers for Paul’s healing and recovery.  We still have no idea exactly what the illness was, but we are thankful for a Big and Sovereign God who knows all about us and about every detail of our past, present and future.  We are in His hands and we can rest in that.

So, how is Paul now?  He is doing better, he is taking it slow, but slowly getting his strength back. We rested all of Saturday and Sunday.  On Monday he rounded on patients in the morning, came home and rested and only went back for an emergency.  On Tuesday, he rounded and did a minor procedure.  Today, he assisted on one major case and then sat through conference.  So he is slowly getting back his strength and I am proud of him for taking it slow and taking time to rest this week.  That brings me to the other huge thanks…our newest surgeon, Jon Pollock, what an initiation it has been for him.  Thankfully, he has been here 2 other times, where he worked with Paul and the residents and knew the routine, because within less than a month of them touching ground in Ethiopia, Paul was laid out on his back for several weeks.

So, that is the story, at least my side of the story.  I have enjoyed being home and I am looking forward to my parents coming here in less than 2 weeks!  Which means, I am also working on finishing several house projects before they get here…painting the bathrooms, recovering a few cushions, making some food to have in the freezer, etc.

Again, thanks to all of you for sticking with us through this trial and continually praying for health and renewal for Paul.  We love you and miss you!

Thank you all so much for every email, prayer, and thought of encouragement.  It means so much to us.  I want to write more about this whole adventure, so hopefully I will do that this weekend.  love, Becca