The Road to Gimbe
Article & Photos By Pete Stiles
The following is a collection of excerpts from a series of journal entries written between July 4 and August 14, 2004. Scratched on suture packets and prescription pads, typed on an old laptop in the back of Land Cruisers and ambulances, it chronicles the events of a medical adventure in the Western Highlands of Ethiopia.
7/14
The trek from Addis to Gimbie is only about 440 kilometers, but it takes ten hours in personal vehicles and anywhere from 15 to 30 in a public bus. I’m sitting in the front passenger seat of a rugged Toyota Land Cruiser. The road, if it can be called that, is a series of potholes, ditches, washed-out bridges, and boulders. The bumpy ride is redeemed by beautiful scenery. It’s the rainy season here at 8,000 feet and the mountainous world, carpeted with green, teems with life. Thunder rolls and lightning flirts with the peaks, but rain is still miles away. A hundred shades of green quilt the expanse.
The road is saturated with domesticated animals. Herds of cows, sheep, and goats wandering in our path force us to slow our pace. The shepherds are no older than 15, some as young as seven. I see small children in charge of 20 cows. When the roads are too thick with animals we come to a complete stop and children run up to my window, holding up their hands for high-fives. They run along the side of the car until their short legs can carry them no further.
There are fields, but no crops grow. The farmers still use mules to plow their acreage. Large acacia trees pepper the fields. Mountains climb toward the clouds on the horizon. The water runs dark and muddy. Only 20 percent of the population has access to safe water. Donkeys and humans wrapped in rags line the road. I can’t get over the sheer number of people here—73 million in a country just twice the size of Texas. A strong majority of Ethiopians are unemployed. As far as I can tell, all the problems in this country stem from an overwhelming lack of education. To keep from going crazy, one must realize this fact and act accordingly—respect the people, but never try to reason with them or analyze their logic.
7/15
It’s the evening after my first day at the Gimbie Adventist Hospital, an outreach mission sponsored by Adventist Health International. We arrived around 1 a.m. this morning and I was immediately ushered to the apartment that I’m sharing with Bryan. It’s quite habitable, a veritable palace compared to the grass and mud huts that surround us. We have a humble kitchen where we’ll be making most of our food. There is a bathroom and two bedrooms. In a city of 30,000, our compound is one of five buildings with electricity and the only place with relatively safe running water.
Up the hill, there are 80 beds in the hospital divided into three wards—men, women, and pediatrics. We have an emergency room, operating room, delivery room, and blood and X-ray labs. Nestled among these areas are offices, bathrooms, and cashier booths. The hospital charges a fair price, but still must turn away some sick people because they cannot pay. Due to its remote location, the building took seven years to complete.
My first night I ventured out into the streets of Gimbie; many of the locals had never seen a young white man. Most just waved, but the children walked along with me. They became worthy companions, pushing livestock out of my way and helping me avoid pickpockets. I introduced myself to four or five of the children and they responded with their names, which I could not pronounce. Holding the hands of four boys, with at least four more locked arm in arm, I led our troop down the main road. We made quite a spectacle.
7/18
After a wicked bout with what we will call food poisoning last night, I’m still feeling queasy and weak. The time I didn’t spend doubled over, I spent in the Muggii clinic. Throngs of people lined up to see the white doctors. The overworked staff and I will be hard pressed to see all the patients by the time we leave on Tuesday afternoon. Sounds of crying children and whooping coughs emanate from patients waiting outside. The scent of vomit from a group of malaria victims saturates the air. Three small rooms in utter disrepair constitute the clinic. A few wooden tables and chairs furnish the place. The whole facility is lit by two flickering 40-watt bulbs that swing from the ceiling by exposed cords. I sat on a tree stump, freeing up the few chairs for patients. From 9 a.m. to 6 p.m., we treated everything from malaria to hookworms, tuberculosis to hypertension.
A patient entered, her poor immune system making her an AIDS test candidate. The doctor inquired, “What are some ways to protect yourself from AIDS?” She confidently responded, “By following the good Lord’s way.”
During our lunch break, I opted to sit in the Cruiser and rest my weary stomach. After just a few minutes of sitting quietly and reading, a group of inquisitive children gathered at the windows. They peered in at my book, whispering to each other, not thinking that I’d noticed all 27 of them creep up. Their innocence was splendid. Completely unaware that the rest of the world has clean water and porcelain toilets, they are content stomaching silt along with water and squatting under a nearby tree to relieve themselves.
I can’t help but smile every time I hear people speak in Oromofa, the language of Walega. The words blend into a song, completely foreign to an English ear. The verbal score is highlighted with trills and punctuated with lip smacks and tongue clicks. Picking up a few basic phrases and exchanges, I can greet people, tell them to wait, stop, goodbye, thank you, and say the equivalent of cool (ishi).
7/23
This morning will forever be locked in my memory, serving as a tangible reminder of why I want to dedicate my career to medicine. Zenabu, a little girl with a broken leg, could wait no longer for an anesthetist to arrive—she desperately needed a skin graft to cover the open wound on her left lower leg. Over the past weeks Dr. Jack, Bryan, and I have been building up a trusting relationship with the brave young girl so when the time came for surgery she would remain as calm as possible. Each morning I greet her with a smile and a trinket from the bag of goodies I brought for children—I give her balloon animals, Koosh balls, and coloring books. This morning I hung a pink and purple necklace around her protruding collarbone.
Dr. Jack needed our assistance for the skin graft. We discussed the plan of action before donning surgical gowns and sterile gloves. I could hear Zenabu whimpering as the nurses wheeled her down the hall. The bright lights and gleaming metal clearly filled her with anxiety. Yet upon seeing familiar faces in the operating room, she broke into a beautiful smile. Reassured, she bravely lifted her gown so we could prepare the skin donor site.
I brought my laptop into the operating room to play some soothing guitar music in hope of calming Zenabu’s nerves. She closed her eyes and listened as the anesthetic claimed her consciousness. I guided the blade while firmly holding her thigh so we could achieve a clean cut.
Little Zenabu regained consciousness just as we finished the procedure and wrapped both the injury and donor sites in gauze and Coban. When she heard the operation was complete, she grabbed my hand and pulled me close. Still groggy from the anesthesia, she gave me a big hug and mustered an enthusiastic English “Thank you!”
7/24
A foreigner cannot go anywhere without a tail of curious Ethiopian children. By the time we arrived at the Frisbee field today, our entourage served as an audience. Charlie, an American who has been in Gimbie for three years, has shown these kids both a sternness and kindness that they lack from distant or deceased parents. He clothes and feeds them, but also holds them responsible for their actions. They’ve come to fondly call him Boona, “the strong, confident one.” The group of boys that followed us to the field is colloquially called “Boona’s Army,” a rag-tag group of orphans who listen to no one but Boona. All these children need is a little structure and love.
7/30
I’m writing from Chandra and Charlie’s back porch while Bryan plunks out one of the four songs I’ve taught him on guitar. Chandra is Gimbie’s hospital director, and Charlie, her husband, works at the hospital to fill the many gaps inherent to Ethiopian medical facilities. Bryan’s melody battles the chatter echoing from the mosque’s PA system. My view of the horizon, divided into vertical slits by the giant eucalypti in front of me, looks out on a few rusty shanties. Misty Mountain (Bryan and I named it for its constant ring of clouds) rises up from the horizon. The clouds that hang overhead threaten rain, but we’ve remained dry so far today. My sweatshirt keeps me comfortable in the 65-degree breeze. I often spend my quiet evenings with a guitar and notebook. Thunderstorms frequent my evenings here in Gimbie. I can watch them roll in across the valley and bask in their rumble.
The hospital had a low census this morning, so I was able to spend some time with three children in the pediatric ward. One little boy can’t seem to stop smiling, despite an inguinal hernia. I wear a bracelet on my left wrist and when I brought him his very own from my bag of goodies, he looked as though he could fly.
We handed out toothbrushes to each of the children. The kids received the brushes with puzzled expressions—we needed to demonstrate how to use a toothbrush! Once again, we showered Zenabu with balloon animals after changing her dressing; once again we were stopped by the man awaiting an amputation. He remains convinced that I have a magical drug that will rid his leg of skin cancer. He pleaded with me for the enchanted prescription, citing that he couldn’t work without his leg and his three children would starve. I could only empathize and explain that his children would also starve if he died...it appeared as though tears would flood down his weathered face, but he accepted the truth in silence. Later in the day, Bryan brought him some food in an effort to personalize his care and demonstrate that we valued his well-being.
A troupe of monkeys greeted me when I returned to our apartment. Hunger quickened my step when I left the hospital, but upon seeing the welcoming party I became enthralled with my new primate friends. A large group lives in the banana trees next to my bedroom window. These tree-swingers’ curiosity draws them within feet of my room. One brave little guy even hopped up onto my windowsill. The world’s best zoo now lies outside my window.
This morning I struck the last borrowed match to light the stove—it was time to venture into the heart of Gimbie to find some necessities (matches, toilet paper, and cookies). Boona’s Army met us at the hospital gate and didn’t allow more than an inch to come between my skin and theirs once outside the compound. I joined Boona’s Army for a walk into the center of Gimbie; they led me by the hand all the way to the end of the road. They began with their usual regimen of begging: “Mother, father dead, give me food! Give me shirt! I love you!” Then they mentioned something surprising, “Give me book!”
I responded, “Malifi? (why?)”
“I learn English, need exercise book.”
“Give me pen.”
“Give me exercise book.”
“School, there, I go soon, I need book.”
These kids are sleeping in mud, surviving without parents, and starving, yet they asked for English books. They recognize that education might provide a ladder up which they can climb from the pit of destitution.
8/2
As an aspiring American physician, I harbor great respect for American doctors. After spending time with Ethiopian practitioners, however, I’ve developed an even deeper respect for these outstanding individuals. Ethiopia supports just five medical schools (two of which were established in the last eight years) with an average class size of 50 students. The average Ethiopian physician makes less than $300 per month. That’s about a third of what Americans make on minimum wage.
Due to restricted travel from heavy rains, the hospital echoes with emptiness. One of the two women in the ward arrived last night after poisoning herself. The woman, considered entirely rational by cultural standards, believed evil spirits lived within her abdomen. To purge the spirits, she mixed a concoction that landed her on the first floor of the Gimbie hospital. I’m unsure if the demons are still around, but if she had not arrived, she certainly wouldn’t be.
8/4
Still only a handful of hospital beds are filled, so I had extra time to spend with the few patients. I’m happy to report that Zenabu makes giant strides toward recovery each day. The grafted skin now flanks her other tissue and the donor site no longer requires a bandage. We exchange ear-to-ear grins every time I pass her bed. Soon the broken tibia can be set. With the wound closed, she scoots herself around in an oversized wheelchair—Bryan sometimes kidnaps her and rolls her up and down the hospital ramps. A regrettable side effect of one month of bed rest is muscle atrophy. Her right quadriceps muscle cannot even resist gravity. We have her on a regimen of sitting exercises so that she can amble out of here with the assistance of crutches and a walking cast. Through my daily visits, care, and trinkets, I’ve grown quite fond of little Zenabu. I wish I could bottle her infectious smile and carry it with me back to the States; it makes me sad to think that when she returns to her unfurnished mud hut her life will revert to hardship once more. I hope that I helped plant a seed of hope and that her unwavering optimism will blossom into a happy life.
Today a new face appeared in the private ward. As doctors and nurses filed into the room, her expression remained unchanged—painfully stoic and introverted. She failed to respond to the physician’s questions and stared blankly past me. The doctors mumbled a few words to each other and the medical team retreated. I wondered what bothered the girl, so I stayed back from the group for a moment and asked one of the nurses. The girl’s name is Wakinesh, she arrived late last night—this next part makes my stomach churn—after a savage rape left her torn, bleeding, and hollow. Wakinesh is eight-years-old. She has been incontinent since the crime and urinates uncontrollably in her sleep. Emergency room nurses sutured her ravaged pelvis. The rapist isn’t even being hunted. Law enforcement is unreliable, and even if caught the offender would not be more than reprimanded. The culture simply turns its back, much like the unaffected nurses who fail to give a second glance to the little girl. The mental damage dwarfs the physical harm she incurred. I can see pain and fear in her eyes. I want to reassure her that the world is an inherently good place with some bad things, rather than the opposite. Her blank expression replayed in my head the rest of the morning and on into the afternoon as I sorted more obsolete medical gear. Her nauseating situation grated on me until I could take it no longer. My words would ricochet off not only the language barrier but her impenetrable emotional shield—there had to be a way to connect with Wakinesh. I poked my head into her private room.
Wakinesh’s toddler brother and baby sister perched at the foot of her bed, and her mother rested on a stool in the corner. I had a translator ask if I could break the ominous silence before stepping into the stuffy room with a guitar. I sat on a stool near her head and smiled. She revealed nothing. I strummed a few chords. Still nothing. I started to play and sing. At the end of the first song she returned my smile. The second elicited mild applause. By the third, she clapped along and glowed with appreciation. I hope that my short and humble performance helped to restore her spirits and encourage recovery.
8/5
Wakinesh greeted me with a smile when I entered her room this afternoon. I pulled a stool near her bed and produced the guitar. Before I had even started she laid her tiny hand on my arm and uttered an English, “Thank you, Goftu (sir).” Could this be the same girl that sat motionless a day earlier? Riding on confidence from her response, I plucked out some songs, and she clapped along so enthusiastically that her blanket fell from the bed. My face still hurts from the huge smile we shared.
I later discovered that she didn’t arrive in the hospital until a few weeks after the incident and had been unresponsive and incontinent the entire time; she awoke in a puddle of her urine each morning. One of the nurses pulled me aside and told me that she “properly voided her bladder” last night for the first time in over two weeks.
8/7
After an afternoon rest, I returned to the hospital at 5:30—the time I routinely serenade Wakinesh. I look forward to the event almost as much as she. This brave eight-year-old is completely different from the reclusive girl that arrived four days ago. She interacts and laughs, claps and smiles. I play the same few songs each day, but my limited repertoire matters little. By the end of my second song, all the nurses and many patients and families from across the hall had filed into the small room to listen. Wakinesh is a veritable celebrity now that she has her own ferengi (white person) entertainer. She tugged on my pant leg as I finished playing, so I leaned down and listened to an Oromofic whisper. The nurse translated, “I want to go to America with you.” Touched, I had the nurse respond for me, “You are very special...there are a lot of wonderful people that love you, look around! (pointing to her family) And God loves you very much. You need to be with the people you love and that love you. You need to stay here and make sure everyone gets to see your beautiful smile!” With that I offered a hug, acknowledged her grateful parents, and excused myself from the room. A few tears fell to my blue T-shirt as I retreated down the hall.
8/8
Exhausted from yesterday’s surgery, Bryan and I opted to take a mental health day. I rested beneath the folds of mosquito netting that enshrouded by bed, watching the rain streaking down my window and listening to the monkeys play on the tin roof. When I finally rose, the rain had stopped and rounds were complete. On Sunday, because the hospital does not discharge on the Adventist Sabbath, the hospital routinely empties. Little Wakinesh, included on the list of discharges, headed out this afternoon to face reality. Before her departure, Wakinesh’s younger brother found me up on the hospital’s third floor and excitedly ran toward me to wrap my legs in a hug. I chased him down the stairs to where Wakinesh and her younger sister waited. The traditional natellas (head wraps) signified they were ready to leave. Making eye contact with Wakinesh, who was now bubbly with smiles, I motioned for her to follow me. She and her two siblings accompanied me back to my apartment for some final parting gifts—more bouncy balls, bracelets, jump ropes and necklaces. It was difficult to release my little friend back into the unforgiving world, but I knew her few days at the hospital pointed her down the road to recovery. The first picture I took with her will also be my last. The family gathered their few belongings and stood to leave. Her father thanked me with a look that revealed more than words could say. They turned toward the door and Wakinesh ran back to drape herself in my arms; tears welled in our eyes. I reassured her with a hug—then she walked out of my life. Our friendship was ephemeral, but I hope I left her with something that endures.
8/11
Our last full day in Gimbie: we confirmed flights, traded addresses, signed Chandra and Charlie’s guest book, and packed our bags. While I sorted the remainder of the donated medical gear, Sara, the chaplain, approached me. Sheepishly, she asked me to play a song so she could record it to remember me and the song’s message. I scratched out some modified lyrics and played for her miniature boom box.
I’m leaving the majority of my clothes here. Ashabar gets my fleece jacket and Charlie my cargo shorts. My rain suit will be placed in the Cruiser for breakdowns during downpours. Sixteen pairs of scrubs will please the medical staff. Boona’s Army will divide my socks and T-shirts. Any clothing left here will be put to use more than if I kept it myself. We’re leaving with less than half the amount of baggage we arrived with.
I left Boona’s Army with a hefty parting gift. The e-mails I sent back to family and friends have prompted a cascade of support and already enough money has been raised to enroll the entire Army in school this season. Students must also supply six exercise books, for their lessons in school. As I handed them each six books and a stock of pens, they all promised to study very hard so they could be “like Pete and Bryan.” As our final gift, Bryan and I presented each recruit with a balloon sword. I’ve never seen anyone so enthralled with a piece of latex rubber. The children’s dancing, singing, skirmishing, and fencing were blanketed by a delighted chatter that signified, for the moment—despite hungry bellies, deceased parents and tattered clothing—perfect contentment.
The thought of leaving Gimbie pulls me in two directions. First, I’m excited to see and spend time with those I care about back home. I’m looking forward to crashing on a comfortable couch or futon, watching a movie, and not worrying about being infected with a rare pathogen. On the other hand, I’m scared to leave. So much is left undone—there are mouths to feed, hands to hold, victims to reassure, patients to see, laughs to enjoy, mountains to climb, and memories to be made. Yet, a lifetime here would never complete such a charge. Archbishop Oscar Romero explained, “We cannot do everything, and there is a sense of liberation in realizing that. This enables us to do something, and to do it very well. It may be incomplete, but it is an opportunity for the Lord’s grace to enter and do the rest.” I know my experience—through smiles, nature, friendships, adventures, thank you’s, praise, and love—lit a fire inside me that will shine before others.
The dichotomy I feel about leaving can be reconciled by the way I conduct myself upon returning to my world. My life has been touched by a combination of sentiments—some I penned in my correspondence, some I privately ponder—these feelings are now part of me and my future friendships and relationships. Melding them with my American life, I will forever carry the lessons I learned at the edge of the world.