SCALPEL, SPIRIT AND SEEDS: MY LIFE PROMOTING HEALTH IN ETHIOPIA AND AROUND THE WORLD

By Dennis Carlson

This fast-moving autobiography captures the intriguing life of Dennis Carlson through his personal stories and changing professional careers. He began work in Ethiopia as a missionary doctor isolated by 100 miles from other medical resources; shamans and exorcists were active in the population he served. Later, Dr. Carlson led an innovative public health college in northern Ethiopia dealing with epidemics, famines and rebellious students.

Another career change took him to Johns Hopkins University to create the School of Health Services for training health practitioners to work in underserved communities. When drought and famine hit Ethiopia again in the 1980s, he returned to assist in food distribution and community recovery. Carlson stayed in Ethiopia and assisted development of seven new health science colleges. He also led the introduction of family vegetable gardening in northern Ethiopia during a time of drought and social instability.

This masterpiece will intrigue all who are interested in reading about a fascinating and challenging life. Those in health fields will find innovations Dr. Carlson made to be useful in many health crises.

“The reader will be rewarded with Dr. Carlson’s sense of adventure, his sense of humor and his sense of mission and meaning.” Greg Fricchione, Professor, Harvard University

• Language: English
• Publisher: Gatekeeper Press
• Release date: May 7, 2024
• ISBN: 9781662945724

Book preview

1

Door of Life Hospital

Ambo, Ethiopia

1958-1962

Let’s get down to the hospital quickly and see the emergency patients. It was early on our first morning in Ambo, Ethiopia. Dr. Tom Coleman’s urgent tone told me there was no time for pleasantries. My wife Louise and I, and our two-year old son, Andy, had arrived the evening before from Addis Ababa, curving down the hills around Ambo into the open valley, our assignment for the next four years.

Tom was a giant-hearted, Swedish-American surgeon from rural Minnesota and a man of few words who had arrived in Ambo with his family two years before us. The Coleman and Carlson family histories had been woven together for more than forty years; both families had been immigrants from rural Sweden.¹ My father had served his first student pastorate in Springvale, Minnesota in 1925, where Tom was growing up; Tom’s family hosted the budding preacher for dinner many Sundays. We both had been premedical students at Bethel College in Saint Paul, Minnesota. Now Tom and I would be colleagues in the new mission hospital in rural Ethiopia sponsored by the Baptist General Conference, previously known as the Swedish Baptist General Conference.

Door of Life Hospital 1960

Tom knew there were three patients with urgent surgical problems waiting for us: a farmer with a pelvic abscess from spear wounds along his rectum; a ten-year old shepherd boy, who had detonated a live Italian hand grenade he found while tending his family’s cattle; and a young woman in obstructed labor. As soon as we arrived at the hospital Tom announced, OK, let’s scrub up and get started! Dennis, you do the surgery, I will help you. Stunned by being thrust so abruptly into the lead surgical role, I thought, I really don’t have a choice, this is what I’ve been preparing for, and took the scalpel.

We drained the abscess and a few days later the farmer was on his way; the mother and newborn did well during and after the caesarean section; the shepherd lad had been blinded, lost an arm and a foot in the explosion and was in shock. All we could do was clean the dirty, ragged wounds and treat his shock. He died that night. I was deeply shaken. Did you actually think he would make it? Tom asked. Yes, of course, I replied in forlorn distress.

*****

Throughout history a wide range of individuals and foreign governments have been attracted to Ethiopia. Early in the Fourth Century CE, the young Syrian Orthodox Christian brothers, Frumentius and Aedisius, were shipwrecked on the Red Sea coast and taken to the court of the Axumite Emperor Ezana, who used them as assistants in court administration; during these years they shared their belief in the Jesus Movement with the Emperor, who embraced this expanding religion about 330 CE and then acted to spread it throughout his empire.²

Another 150 years later, a series of Orthodox Christian monks from Syria arrived to assist in building new Orthodox churches and elaborating Ethiopian Orthodox Church music, theology and liturgy.³ Some scholars agree that informal groups of Christian believers were established along the coasts of the Red Sea before the fourth century, led by Egyptian and Greek merchants who had been converted to Christianity.⁴ The Prophet Mohammed was born in Mecca in 570 CE and, according to tradition, was cared for by an Ethiopian nurse and developed favorable relations with the small Ethiopian community there as he was growing up. When the Prophet’s new religious, social and political movement faced serious, violent opposition, Mohammed sent his family in 616 to live in Axum under the protection of the Axumite king; in 628 CE, when the Prophet’s movement was more firmly established, he sent for them to return home. As Islam expanded and conquered much of north-eastern Africa, the harmonious relations with the Axumite Kingdom ended; throughout the following centuries, Ethiopia was surrounded and frequently threatened by hostile Muslim forces.⁵

Ethiopia was almost completely isolated and unknown to Europeans due to the rugged mountainous topography and religious and military barriers that made travel exceedingly difficult. Europeans had only vague reports reaching Europe that described a kingdom led by Christian kings, especially one named Prester John. When European countries launched the Crusades into Eastern Mediterranean territories from the 12th through the 16th centuries, they urgently hoped they could make military alliances with the mysterious Ethiopian king to increase their military strength as they battled common Muslim foes.⁶

Portugal began to expand its Empire rapidly in the 15th and 16th centuries and intense interest was again directed toward Ethiopia, though this time for fundamentally different purposes; now Portugal wanted to conquer Ethiopia in order to transform the mountain kingdom into a Catholic Portuguese colony and military base in order to protect its thriving trade routes to the Orient. The State and Church of Portugal sent a multi-purpose mission to Ethiopia in 1520 that was intended to lay the groundwork for colonization and stayed until 1526. At the same time the Axumite government was being seriously threatened by Islamic forces; military forces under Ahmad Gragn were poised to conquer all of Ethiopia and force the population to become Muslim. They almost succeeded in over-running northern Ethiopia in 1543, but were defeated by the army of Emperor Galawdewos, who earlier had requested and received the assistance of Portuguese troops stationed in Goa, a new Portuguese colony on the west coast of India.⁷

BLUE NILE FALLS (TIS ABAY)

After the defeat of Ahmad Gragn, many Portuguese soldiers remained in Ethiopia, had families, and worked as craftsmen building houses, bridges and castles. These Portuguese-Ethiopian families provided support for Catholic missionaries from Portugal who persisted in attempting to establish a colony in Ethiopia until the end of the 17th century; in 1622, the Catholic priest Pedro Paez, as religious leader of the Portuguese mission, succeeded in persuading Emperor Susenyos (1607-1632) to become a Roman Catholic, and insisted that he lead the entire Ethiopian society into the fold of the Roman Catholic Church. When Emperor Susenyos and his Portuguese advisors tried to implement their plans, the resistance and counterattacks by Ethiopians loyal to the Ethiopian Orthodox Church were ferocious, causing many deaths of soldiers and civilians; Susenyos had to admit defeat and was forced to abandon the Imperial throne in 1632.⁸

Occasional visitors from other countries arrived during the 17th century, usually practicing some form of clinical medicine.⁹ The new Emperor Fasilides (1632-1670), who followed Susenyos, welcomed Peter Heiling, a German Lutheran missionary to Gondar in 1636; Heiling treated sick members of the imperial court and other Gondar residents, and also engaged in evangelism. In 1699 a French physician, Charles Poncet, living and working in Egypt traveled to Gondar at the invitation of Emperor Iyasu l (1682-1706) to diagnose and treat himself and his son, who had serious skin ailments. In the 18th century, the British adventurer Robert Bruce, the first agent of the British Church Missionary Society, lived in Gondar, explored many parts of Ethiopia and treated thousands of patients, though he too had very limited medical training.¹⁰

European interests in Ethiopia intensified in the first half of the 19th century; individual visitors from France, Germany, Switzerland, Armenia and other countries arrived; both the French and the British governments sent competing official scientific and diplomatic missions in the 19th century to enhance their imperial interests; the French stayed from 1839 to 1843, the British from 1841-1842.¹¹

The pace of African colonization by western European powers increased even more in the second half of the 19th century. Only after Italian city-states were unified in 1861 into one stronger nation were they able to compete in the Scramble for Africa by European powers, with the Italian goal being to conquer the highlands of Ethiopia. They acquired ports along the Red Sea coastline and obtained access to the highlands of Eritrea. When the Great Famine of 1888-1892 devastated Ethiopia, the Italians believed they had an opportunity to defeat Ethiopia with relatively little trouble. Much to their shock and horror they were overwhelmed by Menelik’s army with over 100,000 well-armed troops on the plains around Adwa on February 29, 1896. The Italians were utterly defeated and suffered enormous loss of life, as did the Ethiopian forces. The foreigners felt humiliated because it was the first time that an African army had conquered a European military force. The Italian army quickly became the laughing stock of Europe.¹²

Four decades later the Italian fascist dictator Benito Mussolini used these memories of humiliating defeat in Ethiopia to help motivate building a powerful army and an air force that could drop bombs and poisonous gas on Ethiopian ground forces. These vastly unequal capabilities allowed the Italian army to subdue and partially control much of highland Ethiopia from 1936 until 1941.

The modernizing Emperors during the 19th and 20th centuries, including Tewodros ll, Yohannes lV, Menelik ll and Haile Selassie l, were willing, even sometimes eager, to have foreign religious missionaries come to Ethiopia, but only if they had capacities to provide some modern services such as health, medicine, agriculture, construction, education and even manufacturing weapons and munitions.¹³

There was one important condition: missionaries were forbidden to settle in northern areas (i.e., Eritrea, Tigray, Amhara, Gojjam and Shewa) where the Ethiopian Orthodox Church had been established for more than a thousand years; Ethiopians had learned with anger and frustration that some foreign missionaries caused serious religious, cultural and political damage. Nonetheless, religious missions were welcomed if they restricted their activities to southern and southwestern Ethiopia, where the presence of the Orthodox Church was more recent and less deeply rooted. This meant that developmental efforts in health and education could be carried out in Oromo, Sidama, Wallamo, Kambata, Gurage populations as well as in other of the eighty ethnic groups present in Ethiopia.

Regrettably, some staff members in Portuguese, French, and British missions acted as independent political agents to urge their supporting governments in Europe to establish a colony in Ethiopia, by force if necessary. That these painful memories and hostile feelings continue to be remembered was made clear in 1996 when former students and colleagues met in an academic conference at Lund University in southern Sweden to celebrate Sven Rubenson for his dedication to Ethiopian Studies. Rubenson had come to Ethiopia as a Swedish Lutheran missionary/teacher and later was employed as Professor of History and eventually appointed Dean of the Faculty of Arts at Haile Selassie l University. The 20th century Ethiopian scholars who presented papers at Lund expressed their sincere appreciation and respect for the labors and devotion of many Protestant and Catholic missionaries who have served Ethiopia diligently. However, other serious questions and challenges were asked about why missionaries felt compelled to try to change some of the central beliefs and practices of Ethiopian Orthodox Christianity and showed little respect for Ethiopian clergy and institutions, while trying to subvert the efforts of the Ethiopian government.¹⁴

Despite significant resistance and ambivalence toward religious missions, foreign efforts increased markedly during the latter 19th and early 20th century, as Swedish, British, Swiss, German, American Protestant, and French Roman Catholic mission organizations worked to establish and strengthen their programs in Ethiopia; a variety of Protestant missions from the English-speaking world, particularly the United States, Canada and Australia, established new religious programs in Ethiopia in the early and middle parts of the 20th century, including Presbyterians, Baptists, Mennonites, Lutherans, Sudan Interior Mission and Pentecostals. They brought significant financial and human resources necessary for development of rural missions in southern and western areas of Ethiopia.

Emperor Haile Selassie returned to Ethiopia in 1941 when the Italians were driven out with British military assistance. However, he had difficulty regaining the authority and control necessary to implement his new governmental program because the British government was working to control Ethiopia as a protectorate and clung to key administrative and military control within the country. Deliberate British obstructionism blocked many of Haile Selassie’s efforts to move rapidly in modernizing the Empire, particularly in education and health services.¹⁵

Emperor Haile Selassie decided in 1943 to appeal to the American government to assist him in recovering managerial control of his government and pushing the British out. The United States was eager to help in this political strategy and sent legal, financial, and other experts to play temporary roles in the Ethiopian government. Ethiopia reciprocated by authorizing the building of a major American strategic diplomatic and military communications center in Eritrea at Kagnew Station. In the early 1950s the United States Government also provided major funding and personnel to collaborate in the creation of a public health college and training center in Gondar and an agricultural college and training center in Harar. It seems likely that these agreements made a significant difference in how willing the Ethiopian government was to permit new American religious missions to become established.¹⁶

*****

This was the context in 1948 when the recently renamed and reorganized Baptist General Conference sent a delegation of two veteran missionaries to seek an audience with Emperor Haile Selassie to ask permission for a new mission that would provide health and educational programs along with evangelism activities. One of the representatives had served in Ethiopia under the Sudan Interior Mission in the 1930s, knew the Monarch informally from previous encounters and spoke the national language, Amharic, fluently. The proposal for a new mission was accepted by the Emperor who authorized two new undertakings, one in Ambo, 80 miles west of Addis Ababa, where a hospital and clinic would be opened and the second in Bekoji, Arsi, where an elementary school and clinic services would be started; both were located in predominantly Oromo communities that had few medical or educational facilities. There was no obvious opposition by local authorities in Ambo or Bekoji to these new Protestant activities; local communities welcomed their presence and used their services extensively, but, even informal communication between Ethiopian Orthodox clergy and foreign missionaries was uncommon. Anger and resentment toward foreign missionaries continued to be felt by many Ethiopian Orthodox Christians in government and academic communities throughout the 20th century.¹⁷

*****

After opening its doors in 1950, the new Door of Life Hospital in Ambo established a reputation as the preferred place for patients with severe trauma, high fever, difficult childbirth or other life-threatening illness in a population of approximately 500,000 people in the hinterlands along the road from Addis Ababa to Nekemte. Most patients still consulted traditional healers, either before or after their visits to the Hospital. Heavy trucks, with dozens of people riding on top of the loads, occasionally rolled off the road as they moved thousands of tons of grain to Addis Ababa, the capital of Ethiopia, along the curving gravel roads and caused many people to suffer fractures, dislocations and lacerations; one 12-year-old boy had a depressed skull fracture which the surgical team elevated and he soon recovered. Patients with severe cases of malaria, meningitis, typhus and relapsing fever came to the Hospital. During the harvest season in August and September, many people ate large amounts of raw corn that led to intestinal volvulus (twisting of the large intestine) which we treated surgically. Occasionally a patient with rabies or tetanus appeared.¹⁸ One man died in the hospital with severe smallpox at the time when smallpox was almost eradicated in the rest of the whole world.¹⁹

Since the nearest hospital from Ambo was 80 miles away in the capital of Addis Ababa, poor or desperately ill patients in the Ambo area were left with no choice but to come to the hospital that had been named the Door of Life Hospital.²⁰ My baptism by fire in the operating room continued as I worked with Tom in performing a wide range of surgical procedures, while also supervising the busy outpatient clinic.

The scene changed dramatically a few weeks after our family’s arrival; Rev. Per Stjärne, the gracious and energetic head of the Swedish Lutheran Mission in Ethiopia, came to Ambo with an urgent request: "Please, please let us have Tom and Elaine in the Nekemte Hospital for a few weeks; our physician almost died, and we had to evacuate him to Sweden." It was impossible for us to refuse. Within a few days Tom and his wife Elaine, who was also a nurse, plus their two young children were packed and headed 150 miles west to Nekemte where the Swedish Mission had been established at the beginning of the 20th century.

That left me, 27 years old, with two years of post-medical school surgical training and five months tropical medicine education in London, and Sandy, a tough, retired U.S. Army nurse from Chicago, to run the hospital. Sandy insisted on trying to manage nursing services as she had done in the military, particularly demanding strict obedience to orders, nothing less, nothing more. With more and more patients coming to the hospital, we actually needed to broaden the roles of the five dressers (all-purpose practical nurses) who were responsible for direct patient care. Sandy absolutely refused. She declared "I won’t train them to do anything more, until they do exactly what I have already shown them." My own deep conviction was that people function best when they are continuously gaining more understanding, acquiring new skills and learning positive attitudes in their work; I did not believe that demands for absolute obedience to supervisors and authorities was an effective motivation. Gradually, becoming more and more angry and depressed, Sandy resigned and returned home. I was left to manage the hospital.

Louise and I desperately hoped that Tom and Elaine would make it back to Ambo before September when we expected the birth of our second child. If Tom didn’t return in time, I would be forced to be the obstetrician and manage Louise’s delivery without professional nursing or midwifery staff. Somehow, we managed to keep the busy hospital running, as well as continuing to study Amharic, the official Ethiopian language, two hours a day. One of our teachers was Ato Worku, who had been banished to Ambo by the Emperor for serving as Minister of Communication under the Italian Occupation Government. His sentence included that he was never to look again upon the face of Emperor Haile Selassie. While Haile Selassie was in Brazil in 1960, a military coup in Addis Ababa almost succeeded. Ato Worku came to our home early one morning; he had heard the news on the radio. He informed us about what happened and urged us to stay home and remain calm.

As we had dreaded, Louise went into labor early on a Sunday morning in August, a month before the baby was expected. Louise and the newborn did very well. However, I was a complete mess. I was totally unnerved and walked around like a zombie for several days. Though we were grateful that all had turned out well, I swore that if Louise became pregnant again, someone else must be responsible for her delivery. The Coleman family returned to Ambo a few weeks after the birth, and resumed their hospital responsibilities again for several months.

One November evening in 1958 a messenger came from Emperor Haile Selassie’s rural palace in Ambo to the Coleman residence saying that the Emperor wanted a physician to come immediately to examine Empress Menen Asfaw, who had long-standing diabetes and advanced cardiovascular disease. Tom asked in jest whether I would like to come along and carry my bag. I was delighted of course for the chance to meet the Imperial Couple. We walked the half mile from the hospital up the hill to the modest mansion and were ushered into a very large bedroom. Tom began examining Empress Menen, measuring her blood pressure, listening to her heart and lungs, and checking circulation in her legs. I was intently observing the clinical examination when the Emperor approached and asked me in English about activities carried out by our Mission. I had been studying Amharic, the national language, for only a few months but had the audacity to try to respond in Amharic. What an embarrassing disaster! Soon the Emperor rescued me by returning to English and inquired what our mission taught about drinking alcohol. When I replied that we tried to teach complete abstinence from alcohol, he responded, Don’t you know that the Apostle Paul wrote to Timothy that he should ‘Go ahead and drink a little wine, it’s good for your digestion, good medicine for what ails you.’²¹ What could I say, except to acknowledge that this was accurate? Then the Emperor asked my opinion on the medical usefulness of Ambo Mineral Water, a tonic water bottled near Ambo and sold all over Ethiopia. Seemingly amused, the soft-spoken monarch asked whether the labels on the bottles that claimed to cure a wide variety of illnesses were reliable or not. Not knowing what he was really thinking, I replied that the Pasteur Institute (an Ethiopian/ French health research and laboratory institute in Addis Ababa) attested to its efficacy. Still, he persisted in asking my personal opinion; I was still reluctant to express my skepticism. Finally, giving up on me, the monarch said with a smile, Well, I think it is just propaganda! Then he added that he would visit the Hospital sometime in the next few days as he usually did when coming to Ambo. Of course, this caused the Hospital staff to begin furiously cleaning and painting to make the place look as nice as possible. We happened to have an in-patient from Jimma with far advanced tuberculosis who couldn’t survive without having additional oxygen from large tanks brought from Addis Ababa. On the day that the Emperor was expected to visit, (he carried other titles such as King of Kings, and The Conquering Lion of Judah,) we stopped to see the patient with tuberculosis early in the morning; as we approached his bed he said, "I see you are rushing around preparing for the ‘King of Kings’ (of Ethiopia) while I am waiting to die and see a different ‘King of Kings.’’’²² After we thought for a bit, we were grateful that our patient had helped us put our priorities in clearer perspective.

Emperor Haile Selassie greeting two of the three triplets with Louise Carlson

Soon after the palace and hospital visits by the Emperor, Elaine Coleman became extremely ill with high fever and excruciating pain in her lower abdomen. A year before, as she had approached the end of her third pregnancy, she suddenly started to have massive vaginal bleeding; Tom had been forced to do an emergency caesarean section by himself to save her life. Elaine and infant Eric survived, but we guessed that some contaminated material had remained in her abdomen after surgery that eventually led to what was now a dangerous pelvic infection. We did our best to diagnose what was happening, but didn’t even have a simple X-ray (though a used machine was being shipped from the U.S). Finally, Tom turned to me and forced the issue: I believe she has a life-threatening condition which won’t improve unless we operate on her and find out what’s going on. He asked, Dennis, will you do the surgery? I will help you. Since our families were very close emotionally it was almost like operating on a member of my own family. I was extremely anxious, but, again, there was no alternative; there was no trained gynecologist in Ethiopia at that point. When we opened her abdomen, we found a large pelvic abscess alongside the uterus and removed the entire mass, including the uterus and ovaries. Following surgery, she recovered slowly, with the help of newly developed antibiotics urgently sent from the United States. Shortly after Elaine’s emergency surgery two highly competent nurses, Lois Howat and Gladys Taranger, arrived in Ambo from Canada to help cope with the increasing load of critically ill patients being admitted to the Hospital.

A few weeks later, the Colemans moved to Bekoji, Arsi in south-central Ethiopia, now known as the home of many world-famous Ethiopian long-distance runners. Tom and Elaine established the new clinic and became widely known in the surrounding mountainous areas for their abilities to manage many kinds of clinical and surgical problems. Elaine had not recovered fully from the pelvic infection and again began to have deep pelvic pain and daily fever. Tom phoned to ask that I come to help again. Ethiopia was in its heavy rainy season (kremt) and the 13 rivers and streams between Asella and Bekoji town were raging torrents. Nearly all the bridges built by the Italians had been destroyed. When we got to Asella, I could drive the pickup truck no further; I asked the veteran Swedish physician, Dr. Harald Nyström, who ran the Swedish Lutheran Mission Hospital, if he might have a horse I could use? He apologized, but said I could use the only horse they had at the time, but that the horse was blind in one eye and was suffering from severe diarrhea. There was no other recourse, other than to walk and struggle through the flood waters, so I started out with an Ethiopian guide in the pouring rain, riding the nearly broken-down horse that could barely ford the high flowing streams.

Clouds of black flies made it miserable for me to ride and almost impossible to see. I swallowed multitudes of flies when breathing in as we crossed the plain. It took eight hours to travel the 30 miles before we arrived at Bekoji as night fell. But we made it, soaking wet; my lower backside was one huge bruise where the wooden saddle had banged for hours. After a soaking hot bath, supper and a good night’s sleep, I awoke the next morning, barely able to move.

I operated on Elaine again that morning with Tom’s help and left deep drains that were placed near the original abscess. After a couple days rest, to let my bruises recede, I borrowed a strong, healthy horse with a comfortable saddle from the Bekoji Mission. Because of the aching pain throughout my lower back, I galloped nearly the entire way back to Asella in four hours, instead of the previous eight hours. Unfortunately, Elaine still didn’t fully recover until she was operated a third time by a new gynecologist in Addis Ababa who arrived a few weeks after the Bekoji visit.

Doctor David Ruppert and his wife/nurse Lillian and their children returned to Ambo after a rest period in the United States. David and Lillian had led the initial renovation of the old hotel building and the opening as a hospital. This made it possible for Louise and me to have a few months in Addis Ababa to study Amharic. The most important benefit was that we would be located in Addis Ababa, rather than in Ambo, which would allow us to have much more time for concentrated study and daily language lessons given by our missionary colleague, Dave Sperry, an excellent scholar of Ethiopian cultures; we also took an Amharic language course in the evenings at the University College. Living in the nation’s capital had other benefits as well; I was able to audit a Modern Ethiopian History course at the University taught by Professor Sven Rubenson who encouraged questions by class members, many who were officers in elite Ethiopian military organizations who asked many searching enquiries, especially about Ethiopia’s struggles to maintain independence in the late 19th century. It also happened to be a time when Rev. Billy Graham conducted a four-day evangelistic campaign in Addis Ababa in the national stadium. After the afternoon rally with vigorous music and a fervent message by Graham, Louise and I were invited as missionaries to attend a reception for the internationally famous evangelist; I took the opportunity to ask Graham’s counsel about establishing Protestant Christian higher education in Ethiopia, but he had little to suggest.

On returning to Ambo six months later it was clear that the hospital needed significantly more Ethiopian staff with better training. The mission staff decided to start formal dresser training that followed the two-year curriculum outline of the Ministry of Health for students who had completed at least six years of elementary school. We recruited five young men in their mid-teens, two from western Welega region, one from Gojjam and two from Shewa. All spoke Amharic as well as fluent Oromifa, the language of the Oromo people. Those from Welega Province, Challi and Banti, had completed eighth grade; the others only had six years in elementary school. The curriculum required basic classes in English, mathematics, anatomy, physiology, nursing arts and primary care. Students rotated through all departments of the hospital under close supervision. The only reference literature available was a small anatomy and physiology text developed for training dressers in central Africa, and Merck Manuals that were given to each student. After training the first batch of students, I wrote a small treatment guide that was used for diagnosis and treatment of common diseases in the hospital out-patient clinic, and would serve in the rural clinics that were being planned. The nursing staff put together a manual entitled Patient Care and Treatment which we published locally.²³ We also conducted daily teaching rounds with patients in the hospital wards and weekly Case Conferences where dresser students presented a hospital patient followed by discussion by students and staff. Staff morale and patient care standards improved steadily as hospital staff and students understood more clearly what could be accomplished in that unique setting with few material resources. We also required each student to plant their own small vegetable garden and to construct a simple pit latrine. The Hospital training staff was highly pleased with the proficiency and commitment of the first five students when they completed their second year of training, and looked forward to hiring all of them immediately to work in the Ambo Hospital. To our surprise and dismay, all left after graduation and found jobs in Addis Ababa at much higher pay than we could afford. Fortunately, we had already recruited a second class of fourteen Oromo youths who mostly lived in the countryside around Ambo. This fitted in well with our emerging strategy to establish small clinics in countryside villages and market towns near Ambo.

Second Class of Dresser Students, Ambo 1960

The second time we recruited new students there were many more applicants and we could be more selective. We expanded our testing process so that not only did we examine their language, problem-solving, and arithmetic skills, we also observed whether they were willing to do menial tasks like scrubbing hospital floors. Since by then we were developing a hospital volleyball team and an athletic program that included the three secondary schools in Ambo, I also watched for possible athletic talent by having candidates participate in volleyball games in the hospital compound during the recruitment and selection processes.

Andy had Ethiopian triplet girls his same age to play with; they had been delivered in the hospital, and then cared for by foster parents, Gimja and Bedada, in a small home on the hospital compound. Emperor Haile Selassie provided financial support for the triplets’ care and education until they completed secondary school. Andy learned to love basic national food and would sometimes turn up at the triplets’ home begging in a sing-song way, Gim-ja, Je-ra (for injera, a thin sour dough pancake). Villagers occasionally brought wild animals they had captured to our home to sell. All the family was sad when a tiny deer-like pet died because we really didn’t know how to care for it. In the last year before we left Ambo for home, we bought a small grey monkey that stayed in and around our home.

Following the advice of the senior Government administrative physician in the Ministry of Health, Dr. Fride Hylander, a Swedish physician who had been born and raised in a missionary family in Ethiopia, and with whom I had established a deeply trusting relationship, I developed close working relationships with local government officials, particularly the local district governor, Fitawrari Sahilu Difay, who was widely known as a successful leader in rural development. He was actively promoting the construction of 1,000 kilometers (625 miles) of dry weather roads in order to make travel to and from markets easier; these seasonal roads were constructed and maintained entirely by local community labor. When I suggested to the governor that we collaborate in developing a network of rural clinics staffed by our graduating dressers, the governor enthusiastically agreed and promised to persuade communities to provide clinic buildings and raise money to buy medicines, equipment and supplies. I occasionally traveled with the governor visiting communities where new clinics were being developed and saw him regularly in his offices to give progress reports. Rarely I invited him to watch surgery in the hospital if we had an unusual operation scheduled. On one occasion he came to watch the removal of a 38-pound ovarian cyst from a woman; he was so impressed that he called Addis Ababa to send a newspaper reporter to take pictures of the mass and publish the story nationally.

The Imperial Ministry of Health closely monitored our expanding health services and training activities and directed our mission to build a new treatment and rehabilitation center for leprosy patients in the remote area of Gindeberet about 60 miles north of Ambo, overlooking the Blue Nile Gorge. Leprosy, with its harsh anatomical, social and economic devastation, was widespread in northwest Shewa and southern Gojjam at the time,²⁴ before the beginning of modern treatment with a variety of new antibiotic drugs. The government offered to provide a suitable piece of land for a small hospital near the town of Kachisi that would have sufficient water supply plus space for a landing strip for small planes since the road was barely passable.

A missionary colleague, Maynard Johnson,²⁵ and I were designated to make an exploratory visit, hoping that our old Dodge Power Wagon truck would get us through, even though huge boulders obstructed the track much of the way. Somehow, we managed to arrive at Kachisi despite the obstacles and lurched into the center of the village, a small settlement with mostly grass-roofed houses. We met the local chief, (who had been considered a regional hero for leading Ethiopian guerilla forces during the Italian Occupation), but now was regarded more as an uncontrolled outlaw. He ordered me to go immediately to his house outside the town with medical equipment and supplies to diagnose and treat a relative who had respiratory complaints. He had a horse ready for me to ride that had a wooden saddle covered by a thin blanket, metal stirrups, no bridle or bit, and only one rein to guide the horse. I was hardly an experienced horseman and the horse barely moved as I kicked its flanks and tried to get it into a trot or a gallop. No luck. We just poked along until we reached the edge of town. After another kick, urging it to move more quickly, suddenly, without warning, the horse broke into a wild gallop and we went flying across an open space with huge rocks lining the path. I could barely stay in the saddle much less influence the direction we were heading. As the horse ran headlong through the rocky obstacle course, I feared I would fall off and smash my skull on the very large stones. The single rein in my hands made almost no difference to where we were headed. Then I saw a welcome sight ahead, a flock of sheep was heading toward me. If only I could run straight into the herd, I could possibly break my inevitable fall. Somehow that’s exactly what happened, with the horse moving at high speed. As the horse ploughed into the sheep I was thrown off and made a soft landing on the backs of the sheep and walked the rest of the way to the chief’s house where I diagnosed and treated a teenage youth with long standing bronchitis. I walked back to the village.

In the following days we found a flowing spring and a fairly flat area where a small plane could land. At last, we were ready to return back to Ambo along the boulder-packed pathway. But the truck engine would not start, even while coasting down the last feasible slope to start the engine by compression. At the very bottom of the hill, we sat in the truck, disconsolate; we tried over and over again to get it started without success. Fortunately, under the driver’s seat we found a detailed instruction manual on how to diagnose and repair this model of Dodge Power Wagon. We concluded that a faulty fuel pump was probably the crucial problem. With the help of the repair manual, we fashioned a new diaphragm out of a leather belt. Still, it wouldn’t start, and we had only a faint bit of electrical juice left in the battery. We didn’t know anything else we could do. Finally, Maynard wondered whether the engine would run if we poured the gasoline directly into the carburetor using a tube from a fuel can of gasoline elevated above the engine. We were aware that a dangerous explosion could occur; to our relief it started with a roar. There was just one problem: this method meant that one of us must sit on the fender holding the reservoir can with one hand and a plastic tube with the other. That would be my job. Despite this awkward and dangerous method, we were able to creep and scramble our way over the nearly impassable track. We stopped occasionally to give me some relief from fatigue. After six hours we finally arrived back home in Ambo to the amazement of our families and colleagues as we told the harrowing story. Within two years a new clinical building with surgical facilities, residences and dormitories for leprosy patients had been built in Gindeberet to serve many leprosy patients.

Soon after our arrival in Ambo in 1958 I was given the opportunity to teach a Bible class in English on Sunday mornings for students from the academic, agriculture and forestry high schools in Ambo. I mainly focused on teaching about the life of Jesus and his disciples, and was usually able to get the students actively involved in discussions. The class grew until sometimes forty male teenagers would show up. I wasn’t sure why they came; surely the stories about Jesus’ life are fascinating, especially if they are new to the listener; maybe it was to get a chance to hear and speak American-English. In any event I enjoyed the whole process enormously and it seemed the students did as well.

After some months teaching the class in the small mission chapel on Sunday mornings, Louise and I invited the students to come to our home on Sunday evenings to sing Gospel