Our fledgling ministry has been many things so far. It’s been exciting, interesting, at times uncomfortable, humorous, fatiguing and many others. For me, it has certainly been humbling. I may have trained at a superb surgical training program in the great U.S. of A., but I have a lot to learn about the roles and duties of a surgeon in Africa. Some of the humility I am seeing is due to the challenges of trying to treat advanced diseases of a broad variety with minimal resources. Some of it simply due to the inability to treat at all. I wanted to highlight a couple of patients for you.

Meet Fideyete. She is 21 years old and has had a progressively enlarging mass on her neck. It is now causing her difficulty with swallowing in addition to being unsightly.

Here in Ethiopia, goiters are quite common. They are due to a variety of factors, primarily lack of adequate iodine in the diet. In addition, a common grain used as a staple food further aggravates goiters by interferring with the thyroid’s function. When I first watched the two Ethiopian surgeons here operate on some of these goiters, I was rather appalled at their technique. Compared to the thyroid surgeries I have seen, learned and done in Texas, they seemed rather crude. There was quite a bit of bleeding and they never even looked for certain structures in the neck that we routinely sought in the US. I must confess that my general opinion bordered on arrogance. As is so often the case, my arrogance was reward with a big plate of crow to eat.

My first two attempts at removing these monsters (of which I have NOT seen in Texas) resulted in complications. Both of them were corrected and are doing well, I am greatly relieved to say, by the grace of God. Though I still intend to perform this operation closer to the way I was trained, in particular looking for those structures, I now realize that the method of operation I observed in the Ethiopian surgeons was for a reason. I, the new guy, have much to learn. I helped one of them remove Fideyete’s goiter and feel I am getting closer to doing that operation with skill. Humility is a hard pill to swallow sometimes.

Sometimes, though, even when you do it right there is simply not much that can be done. Meet Tesebe. He is a late teenage boy who came to the hospital with chest pain and shortness of breath. He was originally treated at Soddo about a month before I arrived, having sustaining injuries from a car wreck. He was pretty banged up apparently and stayed a couple of weeks. He had some broken pelvic bones that did not require surgery and was also found to have an abnormal chest x-ray. He had a few broken ribs and air in the the skin and fat of his chest wall that was not supposed to be there. Normally, this comes from the lung, but the lungs looked OK on the x-ray, and, as he was breathing easily and swallowing easily, no further work up was done at that time. Now he was back. His chest x-ray now is shown for you. Some of you will recognize this as bad. His right lung was not visible. As we had no other diagnostic tools to help us, we placed a tube into the right chest in hopes of draining fluid that may have filled that half of the chest. It was possible that his original injury had bled into his chest and was not picked up on his original x-ray after the wreck. No follow up x-rays were taken. Unfortunately, the tube really didn’t drain much and his x-ray didn’t improve much.

To make a long story short (too late, huh?), we eventually put a flexible camera into his windpipe and attempted to reinflate his lung by opening his chest. There was nothing we could do and it appears he likely injured the main airway traveling into his right lung at the time of the wreck. Now the airway is nearly completely closed off and the lung cannot inflate. Our options are not very pretty, even if we had all of the technology available in the US. Unfortunately, we don’t have that and we have little choice than to to watch this. He has already proven he can live with one lung and now we much pray that he does not develop an infection in that collapsed lung. To attempt removing the lung or repairing the injured airway, especially after this amount of time and in a hospital without a ventilator or intensive monitoring, would be folly. Furthermore, his family is poor and he can’t be taken anywhere else (though, given the complexity of his injury, I don’t think there is anyone in Ethiopia who could fix him). The humility now is the realization that there is nothing more we can do. I’ve had the privelege of praying with him and his family many times, though. Even though there is nothing more we can do, I firmly believe it is worthwhile and effective pray to the Lord to watch over him and ask for healing. He has now left the hospital to go home. If you think about it, ask God to protect this young man. I thank God that he loves Jesus and knows true life.

This has been a humbling process and I suspect it will continue to be so. Given what the Bible says about humble people, I thank God for this humbling experience and pray He will mold me into the kind of man He wants me to be. Thank you all for your prayers and concern, your prayers are being heard.

Paul

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