Ethiopia Vignette 1: Desta and Beki
It was June, 2009. I don't remember the exact date, but I know where I was. I was in the yard on our clinic compound in Galana Goche, Burji, Ethiopia. It was comfortable weather, but a little dry and hot. A few little clouds dusted the sky. It was about mid-day. No electricity was in this town, so it was quiet; the sounds of cows or donkeys, or playing children, occasionally cut the silence.
My job for the day was to review clinic supplies and put together a list of things needed for the next trip. As I walked across the yard between the storage room and the clinic proper, Amber came out of the exam room. "Her blood pressure is 170/110. She's pregnant and swollen."
Amber was a surgical nurse from the western section of North Carolina. When she first expressed interest in coming to help us in the clinic, I wondered "what can a surgical nurse, who is used to cleanliness and complicated procedures, do in a little rural clinic out in the bush of Ethiopia?" But I have learned to leave the details to God, and to move forward with opportunities as they present themselves.
So here she was, working with the clinic nurse (who spoke English), with comfort and ease! Patients started arriving at the clinic at daybreak, and the staff arrived about 8 o'clock to a shed full of waiting people. Some lay on the hard benches under the tin roof, while others squatted in the yard. Children were held by their fathers; one was semi-conscious with cerebral malaria, another was dehydrated with typhoid. Babies were held at the breast by their mothers, sometimes so listless it appeared that life was gone.
One by one they came into the simple cement block building. It had 7 small rooms....2 for examination, 1 for delivery and overnight observation, 1 for pharmacy, 1 for laboratory, 1 for injections and dressings, and 1 for registration and records. On this trip I had brought signs to hang over each door frame; the sign proclaimed in the Amharic language the purpose of the room. The signs might help in organization, if the people could read the signs. Their native language was not Amharic; it was one of several tribal languages in that area. Maybe Burjinya, or Gujinya, or Amarinya. But I didn't have those tribal languages in my computer, so they were stuck with Amharic signs. It was the best I could do.
As Amber spoke, my heart stopped. Immediately my mind went to preeclampsia. This is a condition of late pregnancy. The cause for the condition is still unknown. In the old days, they called it "toxemia," blaming toxins in the blood. Then it was called "preeclampsia" because the condition could lead to seizures. Now the common name is "pregnancy-induced hypertension."
In short, the condition hits some women towards the end of their pregnancy. Suddenly the blood pressure begins to climb. It can easily rise to over 200 as systolic and over 110 as diastolic. Simultaneously, the face and hands swell. Often there are other symptoms...blurred vision, headache, abdominal pain. In extreme cases, seizures begin.
Initial treatments are rest in a dark, quiet atmosphere, antihypertensive medicines, calcium, and magnesium. But these measures often have little effect. The only proven remedy for this condition is an emergency Caesarean Section. Without this surgery, the baby and often the mother will die. It truly is a serious emergency situation.
Out here in the Galana clinic, we had no possible means of doing a C-Section. Amber was doing minor surgeries that required only local lidocaine anesthetic. But to do a major surgery like this would be impossible.
I went with Amber back into the examination room. There sat a beautiful woman, sitting quietly in her Sunday best dress. It was a light-weight olive green dress with a jacket and a scarf. Her face was so swollen! It looked like a giant round moon; her eyes were almost completely shut. She was pregnant with her first child, which was due in about 3-4 weeks. Now I felt certain of the diagnosis.
In Ethiopian culture, a woman is very much under the care and responsibility of the men in her family -- her father, her husband, her brothers. This responsibility is taken seriously. Unlike in America, a woman in Ethiopia does not make her own decisions about medical care. In fact, she is often sheltered from information. The men in her life bear the burden of information and decision. And the woman trusts the men with her care.
I did not see any man with this woman, so I began to discuss the situation directly with the woman. Oshe, a church leader, gently pulled me aside and told me, "Her brother is here. Let us discuss with him."
Then I got the rest of the story. The woman's name was Desta. She and her husband were two of the few Christians in the Muslim village surrounding the clinic. Her home was up the hill from the clinic, about a 30-minute walk. Her husband was gone, and she was working out in their field, pulling weeds to help him. She had come to the clinic the week before, complaining of swollen hands. Her blood pressure was only slightly elevated at that time. She was sent home and told to rest. Not realizing the seriousness of the situation, she was out in the field when she began to feel weak and very swollen. So she had donned her Sunday dress and walked down the hill to the clinic. Her brother Woche was one of the guards in the clinic, and he was also an elder in the church next door.
Oshe, Woche, and I came together outside the exam room while Desta sat quietly in her chair. I explained as clearly as possible the seriousness of the situation. I did not want to frighten them, but somehow I had to impress upon them that this matter could not be delayed or minimized. As we talked, they became convinced of the gravity of the situation. Now we worked together to solve the problem.
The nearest hospital was 4 hours away by vehicle, but the road to get there was cut off by the Guji tribe. The Gujis had been fighting against their neighbors, both the Burji and Amaro peoples, to take their land. They are a nomadic people, moving around as the grass ebbed and flowed for their cattle. During times of drought, they need more land, so they often infringe upon their settled neighbors. In 2009 planted fields were destroyed, home burned, farmers shot, and the prized inset plants slashed. The war had been going on for many years. The Gujis were fearless; not even the federal troops from the capital commanded their respect. If these people saw a Burji man driving a Burji woman through their land, it was asking for death. No, going to the closest hospital was not an option.
The next nearest hospital was probably 8-10 hours away, going in the opposite direction. This route would take us along a dirt road, through rivers, for about 6 hours to the town of Konso. At Konso, a 2-lane paved road headed north to the larger town of Arba Minch. A government hospital was in this town; they could do the surgery Desta needed.
In June of 2009 there were only 6 large Isuzu open-backed trucks and one government Land Cruiser in all of Burji land. Five of the trucks were used for commerce, bringing supplies from the outside world into Burji for the businesses of Muslims. The other truck had been bought by the evangelical Christian churches in Burji to provide assorted transportation needs for the believers and ministry in the area. We would use this truck to carry Desta to Konso Town, and then rent a minibus to carry her to the hospital. We planned to leave early the next morning.
As we left the clinic that afternoon, I insisted that Desta ride with me in the front of the truck; her brother piled into the back with her mother. Someone had been sent to locate her husband, who was to meet us in Soyama Town and go with us in the morning.
In Soyama Town, I settled Desta in a little room. Her mother sat beside the bed in a chair. I brought them blankets and pillows. I darkened the room. I gave Desta calcium and magnesium tablets. I prayed over her, and I tried not to cry. I took her mother to my room, just 2 door down, and told her to call me if there was any concern during the night. That night I pleaded with the Lord as I have rarely pleaded. "Please, Lord, don't let Desta die! Please reach from Heaven and save her!"
At 2:00 in the morning, a soft knock was heard on my door. Her mother stood outside. Desta was now complaining of abdominal and chest pains. This was not a good sign. Her blood pressure was now about 230/130. I talked softly to her, soothing her. I gave her some antacid, calcium, and magnesium. Not that I expected it to do any good, but maybe the chest pains were heart burn and the pills would ease her anxiety. Silently I continued my pleading with the Lord. "Lord! PLEASE save her!" (As I am writing this story, the tears are flowing. That precious girl laying in the extreme rural area of Ethiopia, at death's door, with no one to intervene for her medically. To the world, she meant nothing. But how precious she was in God's eyes. And what an honor He had given me to stand by her, to push for her in any way I could. He had given me this honor, but I needed His Hand in the work. I could not do it by myself.)
At 5:00am the truck started up. In the darkness, Ethiopians were gathering for the trip to Konso. We had 5 on our Team from America -- myself, Amber, and 3 men doing construction. Dave and I had been coming to Burji twice a year for several years. I'm guessing it was about our tenth trip since 2004. We had visited many Burji villages, but we had never been to Konso. The 2 churches in Konso were pleading for us to come to them. So our Team of 5 climbed into the back of the truck to begin the long journey. We were all so exhausted by now. The men asked me to reconsider going, they were so tired. "How can we say 'no' when we've already said 'yes'?" I asked. "They are expecting us. If we don't go, it will break their hearts. God will give us strength to do this work." In their true, courageous, sacrificial selves, they squared their shoulders and set their faces to serve, trusting the Lord of the Work to empower them.
I gave orders to pile many foam mattresses into the bed of the truck. Then I spread blankets for Desta. I knew the road would be rough, and I dreaded the effect of the jarring on this woman at Death's door. Pleading in my heart, I made the final preparations, and two Ethiopians helped her climb up into the bed of the truck. They had spread a canopy of plastic tarp over the front section of the truck bed; we put the mattresses up close to the cab and did everything we could to create a shelter from the cold wind.
We pulled out of the church compound in the darkness. I fretted over Desta. I made her lie on her left side, piled blankets around her, talked soothingly to her.
At the rear of truck bed, her husband, her mother, and Woche crouched together. The construction men dozed, trying to get some more sleep as we bumped along the rough road. The only sound was the grinding of the truck motor as it negotiated the mountain turns. Each person was lost in their own world. Desta was my world; in one hand I held her, and in the other the Lord Jesus.
The sun came up, and still we traveled westward. We crossed rivers, wading through the water on a bed of rocks.
Eventually we came to Konso Town and pulled into a little inn. A small cafe hadn't quite opened yet, but somehow we found something to snack on. The construction men began some playful games while Oshe and I began negotiations for the rental of a minibus. We wanted to rent the whole bus, so that the driver would drive straight to the hospital, without stopping along the way to pick up passengers. As always, I stayed in the background. The presence of a white person instantly tripled the price for anything in Ethiopia.
Oshe and Woche discussed things. They settled on the price for the vehicle. We discussed the amount of funding needed for Desta's medical care and their living expenses in Arba Minch. I handed the necessary funds, given by American believers, to Oshe, and he handed the funds to Woche. This was very significant -- the money must go from me to the church leader, and then to the person, as a symbol of the "authority" of the funds. Oshe would oversee the administration, and Woche would give an accounting to Oshe, who would then report to me. Everything decently and in order, yet within the culture of the people.
As we loaded Desta into the front seat of the minibus, I gave final instructions. "Rest!" And I gave a note for them to give to the medical authorities at the hospital. In this note, I summarized the blood pressure readings and what we had done for her. "She needs a Caesarean Section as soon as possible," I wrote.
Desta and her family went northward in the minibus, and we piled back into the Isuzu truck, heading south for the churches waiting for us. A week later, we finished our time in Burji and headed back to the U.S. There had been no word from the Arba Minch hospital. This was not unusual; we were in rural Africa, and people live without knowing.
A couple of months later, I was able to make phone contact with Oshe. "What happened to Desta?" I asked. "She's alive! But the baby died." he reported. The hospital had waited 3 weeks before doing surgery. They waited too long, and the baby was sacrificed on the altar of their delay.
I tried to put myself into their shoes. What were they thinking? Why did they delay? Perhaps it was inexperienced nurses and doctors. The experienced ones can command better salaries in the cities, so they do not like to come to the rural areas where life is more difficult.
Perhaps it was laziness. There is an attitude prevalent among the staff of Ethiopian government medical facilities. They know that after they treat this patient, there are a million more waiting. So why hurry? Why push oneself? Take another cup of coffee, have a little more chatting time. The patients will always be there.
Perhaps it was low regard for human life. The Ethiopian culture today is a reflection of the ancient culture that was caste-like. Slaves were at the bottom; black-complexioned persons next; those who worked with hides next; those in rural area or from distant tribes were next; and at the top was the Amhara tribe, the educated ones, the foreigners. In terms of medical care today, the rural women are considered as having less value, and hence are worthy of less effort than the educated men or the people of the northern tribes or the foreigners with white faces.
Desta was close to the bottom of the Ethiopian social ladder. She was in a rural area hospital. She was in a government facility. And she had no one to fight for her. I have often wondered if the result would have been different if I had gone north with her instead of south with the Team. But at the time, I had no experience with the Arba Minch hospital, and I felt that my place was with the Team. As it turned out, the Team had some dangerous experiences, and the Lord gave us a rich time with the believers there.
So I prefer to give the hospital staff at Arba Minch hospital the benefit of the doubt. I prefer to think that they were concerned about the viability of the baby being born early and the inability of their hospital to support a premature birth. God knows all the details, and His sovereignty rules over all. As much as I sorrow at the death of her son, I rejoice that Desta's life was saved. God had indeed heard my prayer, and had again shown mercy to me.
Desta returned to her village and her field. Her brother returned to his responsibilities in the little Galana Goche church. Her husband returned to his work. And I returned to the other work that God set before me. It was shortly after this trip in June, 2009, that I was diagnosed with a rare, aggressive uterine cancer. So as Desta settled into her life, I settled into surgery, radiation, and chemo treatments. Time moved on.
The people of Burji were devastated by my diagnosis, so in March, 2010, Dave and I went back to comfort them. As we met in the little Galana Goche church, I spoke words of encouragement. "Remember God's character. It does not change. Although our lives change drastically, He does not change. God is always sovereign...before cancer, and after cancer. God is always loving...before cancer, and after cancer. God is always just...before cancer, and after cancer. And we must learn to live in the reality of who God is. We must embrace His character. We must trust Him to be who He says that He is!"
My words were against the backdrop of my diagnosis. Desta sat on my right side, sitting on a rough-hewn wooden bench, without a back. The church walls were mud slapped against some wood saplings. The roof was made of tin sheets, and hanging from the rafters were bunches of corn -- the seeds for next year's planting. They hung from the rafters as a way of keeping them from the rats that roamed the church at night.
This was "home" to Desta. She was oblivious to the setting; she was thinking of the application of my words to her own experience. Just 10 months before, she had passed Death's door; her son had entered the Door, but she continued on with Life. As she looked at my face, she saw the one who had stood between her and Death, humanly speaking. Crying like a baby, she came to me at the end of the service. She hung on me, crying "You saved my life. It is because of you that I am alive, even until now." In typical Ethiopian fashion, it was a group moment. Her mother, her sisters, her aunts -- the whole female section of the church was surrounding us.
"Isosh!" "Shhh....isosh!" I said to her, holding her in my arms. "Be strong. Shhh...be strong!" I told her. Then I held her face in my hands, and said "Ewodeshalu" (I love you). Her face was wet with tears. For the first time, I could see her eyes. Such beautiful big brown eyes! And such a gentle, thoughtful face.
Later that day, her husband brought us a goat. It was a "thank you" gift to us for all we had done for them.
A couple of days later, we had a nice dinner with her family, the church elders, and us, celebrating the Lord's goodness to us.
We returned to the U.S. We took the largest of our teams back in July, 2010. And I left Ethiopia in a cloud of turmoil, possibly never to return.
In the Spring of 2011, I was impressed to communicate something to Desta. So I sent an email to Oshe. "Please tell Desta, 'Do not be afraid to have another baby. God is with you.'" Little did I know that she was pregnant and this was in her heart. It is such a wonderful thing to have the Spirit of God. He knows our hearts, and He is able to bring help from afar to address our needs. And on November 5, 2011, a wonderful email came from Oshe:
good news today for you. Desta delivered safely a baby girl without any
problem. Last time when you write to Desta to pass your message to Desta
I told her with a lot of fear. God is good. He helped her. Desta thanked
you for the encouragement word. A name for baby is Becky to remember you
all the time. We have another Becky in Burji now.
There was a lot of hooping and hollering on our farm the day this announcement came! And the first thing I did was sew a baby quilt for her. On the quilt I embroidered special Scriptures: Matthew 6, Romans 8, Philippians 4, Psalm 139. Each passage had a message for both Desta and Beki.
So today, there is a little Beki living in the mountains of Burji, a rich blessing from God to me. And everywhere she goes in her life, a testimony of the grace of our God will resound.
We serve a God who delights in hearing prayers in the middle of the night; He does not sleep. His heart is open; He has not abandoned the far-off rural areas. He cries with us in desperate situations, and He delights to take action on our behalf.
He is the God who hears, and the God who responds.
February 18, 2012