by Dr. Steve Hawthorne
14 December 2011

One morning I was with a patient when I heard a call crackle over the radio in the hallway of the clinic: “Doctor! Doctor!” Our nurse Ellie answered and a moment later stuck her head in to say the health worker in a neighboring village was worried about a young woman in labor. He wanted to transfer her to us but no car was available on their end.

That presented a difficulty because our ambulance driver had just resigned. The government doctor assigned to us had been away all week, so I was alone with a full waiting room. To get up the mountain to the village and back, I would be gone two hours.

So I asked the nurse to request more details, and suggested we offer to go at noon when we’d seen all our patients. I could hear them shouting back and forth through the static while I finished injecting the arthritic knee of one of my little old ladies. Then Ellie returned to say that according to the health worker, her vital signs were stable but “he had a bad feeling about her.”

These rural health workers may not be sophisticated, but they can certainly distinguish normal from abnormal; I decided we better go.

	Quechua home in rural Bolivia

We arrived at a typical home set in gorgeous highland scenery—a series of rooms surrounding a central patio of bare earth. Dried meat hung from wires in the sun; plows, shovels and coils of rope lined the walls; cats prowled past wooden crates for pears; blackened clay pots sat in the ashes of the cooking fire and wind stirred the dust in circles.

The patient’s name was Roxana—she was 19 years old and having her first baby. Blinded by the glare of the patio, I couldn’t see anything when I first entered her room, but slowly I made her out kneeling on goat skins in front of a chair with several family members sitting around. While her mother tied up a bundle of clothes, Ellie helped Roxana into the cab of the ambulance. I noticed Roxana looked a little puffy and was getting urges to push as we set off with Ellie in the middle front seat holding Roxana next to the door, and the mother with the clothes in the back.

We were passing through the last town before ours when it happened. Roxana’s right arm started to move as if she were waving. All at once, her body went rigid, she stopped breathing and Ellie screamed, “She’s having a seizure!”

I slammed on the brakes and stopped just past an entrance on my left to a school grounds. I backed up while turning to the right, bumping into the low earth embankment along the right side of the road as I did so. Then I pulled left off the road into the school, raced around to the back of the ambulance and snatched out my bag before the mother’s frightened eyes. I threw open the passenger door where Ellie was supporting the unconscious Roxana, tied a tourniquet on her upper arm and shot a dose of diazepam into her vein. I snapped an oxygen mask on her face, slammed the doors and we bolted for home. A bus was in my way on the narrow, winding road so I had a good excuse to flip on the lights and siren too, and fly back in style.

Once in the clinic, we found Roxana’s blood pressure was sky high, so we instituted our protocol for eclampsia. Her cervix was fully dilated, but since she was still unresponsive and couldn’t push, I delivered the baby with forceps. Mother and child then made an uneventful recovery (except Roxana’s kidneys shut down and needed coaxing to start working again). I prayed with her, giving thanks to our loving God for a safe delivery, and life went back to its normal rhythm.

Until four days later when the government doctor returned. He spotted something that I had not noticed in the excitement—a dent in the right corner of the ambulance’s rear bumper—and he threw an absolute fit (“chucked a wobbly” as my Aussie friends say). He notified the health committee and the town authorities. He telephoned the district medical officer. He demanded I write up an incident report.

All the next day as word of the “accident” spread, a long line of townspeople came by the clinic to stare at the dented fender. I had to describe what happened over and over again. The chairman of the health committee requested that I be “more responsible” with clinic property. The following week I was called in front of the town council for an explanation, and again when the district medical officer and administrator came to see.

When I’m feeling squeezed I become more North American. I knew that the government doctor had been censured by the community for his many absences and was using this to deflect criticism away from himself. I also knew that conflict resolution in this culture calls for indirect communication so everyone can save face. But under pressure, I seem to revert to the values of my culture of origin like “don’t tread on me,” “tell it like it is,” “give them a piece of my mind,” and “let the chips fall where they may.”

I felt justified in putting a few questions of my own to the district authorities: Why does this ambulance that was donated two years ago from Venezuela still not have license plates or insurance? Why am I seeing all the patients and being the chauffeur when they are supposedly paying two other people to do that? Why is absenteeism tolerated in a rural health center when it wouldn’t be in the city? How can a dented fender compare to saving two lives? What makes you feel you can demand perfection out of us when you can’t keep our pharmacy supplied with the medicines we need to do our job?

The authorities listened politely but coolly to my passionate little speech, almost as if I were a child having a temper tantrum and they felt embarrassed for me. I gradually realized I wasn’t helping matters and in the end I apologized and promised to unbolt the fender and take it into the city to fix at my own expense.

But no experience is totally bad if it can serve as an illustration for a teaching point, and my wife and I are currently preparing to teach a course on Intercultural Communication. A book I re-read for that course said:

“Westerners, simply by being themselves, create conflict because they operate from a different value base. Directness, confrontation, forthrightness and candid outspokenness are valued and expected in Western culture. In most of the world these same values, even when demonstrated respectfully, are considered rude, unrefined, ill-mannered, discourteous and even contemptuous. It is easy to see how quickly misunderstanding, miscommunication and conflict emerge.”

Another author spoke to me:

“It is sometimes difficult for North Americans to realize that one of the costs of doing business is taking the necessary time to cultivate friendly working relationships with individuals strategically located in business and government. Until this is done, nothing will happen. Who one knows and has as a friend can make a lifesaving difference in an emergency.”

So let me turn this into a request for your prayers that the Holy Spirit will continue to show us how, as Christ’s ambassadors, to engage in different cultural systems; how to help people, maintain integrity, be loving and seek justice without alienating those we come to serve.

Tips for how to pray for our medical missionaries: Praying for our Healers

Also from Dr. Hawthorne's ministry: Building Trust, The Race to Potosí and Teaching for the Kingdom