I am strangely reticent to share what I’m about to write. In reality, it is incredibly wonderful news and I’m fairly giddy with excitement about it. I suppose I’m afraid that it might be too good to be true and it just might all cave in if I broadcast it to the world. But as I look at it, I have to admit that God’s fingerprints are all over it. It probably is too good to be true without Him, but then God’s always been in the business of “too good to be true, but true nonetheless.” So I’ll report it to you with a sense of awe and humility, and praise God for what He has done and seems to be doing.

As I’ve shared many times, we are training surgeons with the Pan-African Academy of Christian Surgeons. And we’ve been in the process of seeking official accreditation for the training for a long time now. In our last snail-mail newsletter, we included a summary of this process to better explain it to everyone. If you would like more information about this, I’ve added it to the bottom of this post for reference. The really quick summary is that we’ve been seeking recognition both by the government here and by an international college of surgeons called COSECSA (College of Surgery of East, Central and Southern Africa). There have been challenges in both directions because PAACS represents a new bird in Africa. Specifically, we are training surgeons outside of the typical university hospital setting. Since we are a first, it’s been slow going in all arenas for every PAACS hospital. In the course of all this, I had essentially given up on the possibility of accreditation happening with the government here. We are just too different than the usual mold. Therefore, I was focusing my attention almost completely on COSECSA. Any progress with the government route was going to require a move by God.

Well, about six weeks ago, we received word that an accrediting team from the government was going to visit our institution and evaluate it. I have to admit that my initial response was not elation but concern. Would we be shut down? This information came to me literally the night we arrived in Addis Ababa for Amharic language school. I was concerned, but Becca and I prayed. God gave me a sense of peace that, whatever happened, He was still sovereign and that He was guiding things according to His plan. If we’re shut down, He must want us shut down.

We began coordinating with the accrediting office and I was very pleased to hear that they wanted to invite an Ethiopian surgeon to come with them to provide an expert opinion. For privacy’s sake, I won’t mention the surgeon who came but he is a fantastic guy. He is extremely bright and I suspect he will someday be the foremost surgeon in Ethiopia. We had already developed an acquaintance and I fully trusted his judgment.

The visit happened a little less than two weeks ago. Many people were praying for it. In fact, we later learned that God had arranged additional prayer. Both our mission agency, Global Outreach, and the hospital’s foundation board, the St. Luke’s Health Care Foundation, are accredited by the ECFA (Evangelical Council for Financial Accountability). ECFA recognition helps indicate good financial credibility in a charitable organization. Apparently ECFA, in the course of their usual activity, selects a different organization to pray for each day during their devotion time. About one week after the fact, the ECFA president sent a note to St. Luke’s and told them that the “just happened” to select us for prayer on March 29th. It was the day of the site visit.

The visit went incredibly well. Everything proceeded smoothly and the program was presented with what seemed to be clarity and understanding. Questions were answered and misconceptions cleared. It seemed very positive when they left. We continued to pray fervently.

You see, the whole situation just seemed so remarkably different than the prior experiences. Where everything up until now had been a difficult, uphill climb, it seemed strange that this had happened so suddenly and smoothly. It didn’t fit. Only God’s movement made sense of it all.

Two days ago, I received an email. The letter of accreditation was ready to be picked up! I now have the precious document in my possession and will soon get it down to Soddo. After all this work and all this prayer… literally two years of effort… it seems so odd and stunning to say it. We’ve got it. We’re accredited! Again, the last several weeks have been so discordant with the rest of the process that it more clearly contrasts to me that God has done a wonderful thing here.

So what does this mean? I’m still wrestling with the situation. Ultimately, the final test will be whether or not our graduates are granted a license of ‘surgical specialist.’ But it really looks like that is going to be the case. Assuming that happens, I believe it’s going to dramatically affect our program. In the last six or nine months, the number of applicants to PAACS has dropped considerably and Ethiopian applicants have completely stopped. As I’ve talked with Ethiopian doctors, the issue of accreditation has been foremost in the discussion when it comes to PAACS. With this in place, I suspect we’re going to have no shortage of Ethiopian applicants. Furthermore, it may very well translate to doors being opened for our non-Ethiopian residents. Having a governmental license in surgery, while obviously completely useful in this country, would probably be transferable to other African countries.

As I rejoice in this news, I find myself freshly motivated to hit our program with renewed gusto. I think we’re doing a good job but we can be even better. My prayer is that we would be a truly superlative surgical training program. My prayer is that we would loudly broadcast the very best that we have to offer because of what Christ has done in us and is enabling in us. If there is any good in what we are doing, if there is any good in any of us, please understand that it’s God working in us. We don’t claim the credit and I pray that God would receive much praise and glory for all of it. Thank you all for your prayers and keep them coming. They are being heard!

“For who has known the mind of the Lord, or who became His counselor? Or who has first given to Him that it might be paid back to him again? For from Him and through Him and to Him are all things. To Him be the glory forever. Amen.” Rom 11:34-36

Accreditation Summary

Dear Friends and Family,

I’ve written several times in newsletters, prayer letters and blogs about our pursuits of official accreditation for PAACS but we feel we should more fully describe it for clarity’s sake and since it’s such a big deal. To better set the stage, let me describe how it works in the United States. If I want to practice as a surgeon somewhere in the States, hospitals and insurance companies are going to want to have some evidence that I’m a fully trained surgeon. I do that by showing them my certificate from the American Board of Surgery that says I am “board-certified” in general surgery. The only way I could get that certificate was to pass a written and oral test after completing five years of training in an accredited residency program. To be accredited means the program was evaluated by the accrediting body and found to meet requirements that ensure appropriate surgical education is happening there. On the plus side, accreditation ensures that minimum standards are kept in education. On the negative side, accreditation becomes a doorway through which education must go to be formally recognized by society as a whole.

The goal of PAACS since its inception has been to train African Christian surgeons to staff Christian hospitals in Africa. Rural Africa is where the greatest need is and Christian mission hospitals are providing a significant proportion of the care in this setting. Furthermore, these hospitals are proclaiming the life-giving gospel of Jesus as well as treating medical problems. By and large, to function as a surgeon in these hospitals, the doctor just has to be a doctor and be competent (so that you’re not causing problems by hurting people). Official recognition as a surgical specialist is usually not necessary so official recognition was not initially sought. By God’s grace PAACS has been and is growing. We’re not so under-the-radar anymore and we’re at the point that we need to seek participation with official institutions and gain their approval and accreditation of our academic endeavors. I rejoice in this because it is a chance for us to share what we have to offer in an environment that is trying to meet big needs and demands with too few resources. It is also a chance for us to model Jesus to a secular humanistic world and I pray we do it well.

In addition to its role in Christian witness, official accreditation of PAACS will also help many graduates as they move out from training and into the world. They will have the skills. Accreditation will give them official recognition of those skills and will often open the door for employment, especially in areas where there are no mission hospitals. This is especially true of our Ethiopian residents. Related to this, we have a pressing need for accreditation for our program in Soddo because we’re having difficulty finding candidates to join the program. There are many high-quality Christian doctors who aren’t applying for PAACS because they reasonably need some sort of accreditation at the end of their training, especially if they desire to work in an area without a mission hospital.

So how are we going about this process? We are engaged in two related avenues of approach: accreditation by the Ethiopian government and accreditation by the College of Surgery of East, Central and Southern Africa (COSECSA). One of the greatest challenges we are facing with accreditation by the Ethiopian government is that we don’t fit an established mold. In the United States, nearly half of the surgical residencies are not associated with a university. They are considered “community-based” and the training is done in medical centers unaffiliated with universities. If we are accredited by the Ethiopian government, it will be the first “community-based” training program in the country as all of the established residencies are associated with universities (“university-based” in the American lingo). This has understandably led to a slow process.

However, God has graciously supplied many sympathetic people who think we are doing decent work and who feel that the “community-based” system may be particularly effective in addressing the medical needs of Africa. Soddo will soon be visited by a team from the Ethiopian educational accrediting body for evaluation. Should this go well and educational accreditation be provided, it will be up to the Ministry of Health to decide if it will grant PAACS graduates licenses of “Surgical Specialist”. If all of this proceeds successfully, our graduates will be recognized as surgeons by the government of Ethiopia.

The second area of accreditation we are pursuing is with COSECSA. This is an international college of surgery that seeks to provide quality accountability and testing for surgical graduates for several countries in east, central and southern Africa. In is quite similar in function to the American Board of Surgery. It is patterned after the British system and has two basic levels of accreditation: membership and fellowship. In order to become a member of COSECSA, residents have to complete two years at an institution accredited by COSECSA for membership level training and they must successfully pass a written and oral exam. In order to become a fellow of COSECSA (i.e. a fully-trained general surgeon), residents must first become members and then they must complete three years of training at institutions accredited at the fellowship level, after which they must pass another written and oral exam. If PAACS residents can become fellows of COSECSA, their standing as fully-trained surgeons will be recognized in the countries participating with COSECSA. Ethiopia has not officially recognized COSECSA but those debates are well underway and it seems likely that it will. Furthermore, even without an official recognition of COSECSA, there is a reasonable possibility that COSECSA fellows would be provided licenses of “Surgical Specialist” here in the country.

So far, both of the PAACS hospitals in Kenya, Tenwek Hospital and Kijabe Hospital, have received full COSECSA accreditation through the level of fellowship in general surgery. This includes two years of membership level and three years of fellowship level. Here in Soddo, we have received two years of membership level accreditation but that is all. We are requesting that COSECSA visit our site again, hopefully in early 2011, so that we can be evaluated for two to three years of fellowship level accreditation. Even if we are only granted two years, it will allow our graduates the chance to take the COSECSA fellowship level testing if they spend one year in outside rotations at fellowship accredited institutions such as the PAACS hospitals in Kenya.

Please pray for us regarding these two visits and evaluations of our PAACS program in Soddo. In the end, we truly don’t want special privilege or a double standard but hope to be accurately evaluated for what we actually are. As we seek to honor Christ in all we do, we pray that our quality would be exemplary and a fitting testimony to Him.

Sincerely,

Paul Gray

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