This is Paul; trying to get back into sharing something… anything… with our friends, family, and supporters back home. Becca’s advice is to not worry about writing anything big, but just start with small things.

Though it isn’t small, I want to share how thankful I am for the growing community here in Soddo. It is really amazing how much God has changed the landscape in the last few years. I remember when we first came to Ethiopia; we were supposed to fly over with the Anderson’s, who were in the US at the time. It turned out that Duane was struggling to control his hypertension and had to delay coming by a few months. So when Becca, Nathan, and I landed in Addis, it was a pretty empty scene at Soddo Christian Hospital. The hospital driver met us at the airport and we hung out a few days in Addis with no clue whatsoever about the country, exploring with a few remarkably unsuccessful shopping trips to get essentials. A few days later, Harry Bowers, an optometrist who was serving at the hospital at the time, landed from a trip to Zimbabwe (I think). We were so happy to see him and had a much more productive supply run before heading down to Soddo. For the next few months, it was pretty much just as and the Bowers in Soddo. And Harry didn’t even work in the hospital, doing his work in the separate eye clinic on the hospital grounds.

To look at it now is pretty amazing. Though there are plenty of challenges at the hospital, it is encouraging to see growth and development. And the community has grown so much. I am so thankful for the new families. The Karnes’ aren’t so new now, but I deeply appreciate them both and all they bring. The Gabrysch’s have been a joy. I remarked to Becca this morning while doing dishes how much I miss them (they are in the US right now). Both Jeremy and Christina have been great friends as well as bringing a truckload of needed skills to the work here. The Ayer’s are just plain wonderful. David Ayer’s gentleness, kindness, and godliness convict and inspire me constantly. And Julie and the kids are such a blessing to our community. They are one of the most generous families I’ve ever encountered. And now, after many years of anticipation, the Hardin’s have arrived.

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I am so thankful to have Dave Hardin here, both as a friend and another general surgeon. He and his family are really precious to us. I still remember being hosted by Dave and Karisa when I came to interview for the BUMC residency program while a senior in medical school. The work is still awfully hard and challenging here, but it makes a world of difference to have a friend and partner to walk with. My heart longs for Duane Anderson to get a full-time orthopedic partner for the same benefits and encouragement.

By the way, if there are any orthopedic surgeons reading this – I implore you to pause and consider if this is where your practice ought to be. In addition to satisfying, meaningful work, it is a surgeon’s paradise here. Seriously, honestly ask God if He wants you here.

Anyway, small things. Let me tell you a little about last week. We are in the midst of yet another round of work with national accreditation. Now we have to put together a comprehensive document outlining and analyzing our quality assurance processes (from top to bottom) from an educational standpoint in the program. All told, it will end up being a 50+ page document and will require creating quite a bit of brand new policies and procedures de novo. I do think it will make us better and it is addressing deficiencies that are legitimate. But as ever, it’s a lot of work. This document will then serve as a template for a four to five day audit visit from the authorities. Please pray for all of this. There are elements of this that I can’t articulate in a public place that could be game-enders.

As always! This is one of the incredible aspects of life here that I just never anticipated. For five years now, it has felt like a perpetual dance along an icy precipice, always gazing into the abyss and wondering how long this will last. My greatest consolation is that this seems to be God’s normal modus operandi, stacking the deck so heavily that success can only be attributed to Him.

That isn’t to say, however, that everything is going to work out; at least not how I would define “work out”. This is what keeps the dance so terrifying and exhilarating. God will win, but it might involve our taking a big fall. He is far too big to be boxed in by our expectations or definitions of a win. I’ve noticed that Americans in particular, me included, tend to lean heavily on circumstances and coincidences as a litmus test for what God is going. I’ve listened to dozens of stories in which people have described how God revealed His direction and will to them through a series of coincidences. We tell the stories with a twinkle in our eyes: “I had been praying about this and then I just happened to sit next to so-and-so on a plane who just happened to be reading a book about this. Then a week later this opportunity just happened to come available after…” You get the picture. It’s really kind of weird. You line up a series of what-are-the-odds coincidences and we’re convinced we’ve seen a vision. Never mind how significantly our personal desires affect how readily we notice which coincidences we see…

In this case, I’ve seen what seems to be real growth and development of the PAACS program here in Ethiopia. God really seems to be building something. So my tendency is say, “What are the odds that He could be building all this up to let it fall?” That may well be true, but it might not. God knows, not me. It wouldn’t be the first time that everything looked so right for something, only for it to then crump. I’m certainly not saying I’m hopeless. But it does keep the game interesting! My prayer is that we will keep putting one foot in front of the other in obedience, confident of the final result and victory in Christ, but frankly uncertain of how that will look in the immediate future.

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Ok, I’m not going so well with small things. One advantage of having a couple of gung-ho soldier boys here is that I’m having some positive peer pressure towards physical fitness. My brother Dave and my other brother Dave pitched in and built a PT torture device beside the playground. Hardin has been pulling us into some self-mutilation activities specifically designed to cause global body pain and nausea. What doesn’t kill you…? Yesterday (Saturday afternoon) we were doing some exercises when Ronald, the on-call resident, called me about an emergency case. I could barely breathe to talk with him on the phone. I have no idea what he thought about it. The case was horrible, but it got me an early release from our constitutionals.

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We had a six-year-old little girl who was struck on the head by a tree that had been cut down. She had a closed skull fracture and had significantly diminished neurological function, with lateralizing signs. We took her to the operating room and raised a craniotomy flap and found a large fracture fragment lifted up with brain herniating out of the hole. It was terrible. We removed the bone and cleared away some surrounding bone to allow more space for the release of pressure (which meant more brain pushing out). We tried to carefully remove dead brain with irrigation and suction. Finally we had to just close the skin flap and leave the brain decompressed. We are emailing for advice about further management if she manages to survive. She is still alive this morning, but not much better. Please pray for her and her family. Please also pray for our wisdom and that we would make the right decisions. Hardin and I kind of marveled the other day that, in the final analysis, surgery is actually the easy part of being here!

Love you all,

Paul

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