March, 2018;
I couldn't sleep. My mind was racing, even in the semi-conscious state of near-sleep in the early hours of the morning. Excitement, nervousness, anticipation, hope, so I turned on the lamp and reached for my notepad
Late last evening, I delivered my friends Karen and Yoram to their hotel, crashed in a rented room at 0130, finally turned out the lights at 0215 and my eyes sprang open at 0530.
Today could be the beginning of something wonderful. It has already been wonderful; a parallel world that I dropped into in June 2009, going on 9 years now. This trans-formative experience was brought to me by the late Barbara Latenser, a remarkable burn surgeon whose friendship I was blessed to acquire through the American Burn Association and its international outreach efforts. If my dream comes true, Yoram and Karen will return to Lusaka, Zambia having signed a MOU for the distribution of institutional high efficiency wood-fired cookstoves and medical autoclaves though the Churches Health Association of Zambia (CHAZ).
It will be a lifeline for InStove, the little aspirational NGO with which I have been associated since the beginning of 2013. It will be an opportunity for CHAZ to acquire a revenue producing activity that contributes to stability in funding unrelated to dependence on international aid. It will be an opportunity for countless health care institutions including hospitals and rural health clinics to reliably run their surgical and obstetrical services in places where an unreliable electrical grid and the need to purchase diesel fuel to run a generator to produce electricity threaten the ability to sterilize surgical tools. It will represent a major step forward in my personal dream of seeing mission hospitals in Zambia to become champions for the use of improved cookstoves in the communities they serve. It could lead to improved personal and public health, improved local and regional environmental akafaaf
I awoke thinking of Harriet. I met her in August 2011. She is now 10 years old. She had been in horrible pain for a month when I met her. In her small village, a day's walk/bus trip from St. Francis Hospital in Katete, Eastern Province, Zambia; her curiosity and desire to help her mother with the task of preparing the family's nshima (a form of corn grits) caused her to suffer scald burns to both of her hands. In the hospital one month later, the back of her hands was a sea of bloody granulation tissue. Finger bones were exposed, as well as open joints of fingers on both hands. The right thing to do was to shorten many fingers and use living tissue and skin from the palmar side of her fingers to cover and preserve one functional joint on each finger. Harriot's mother, barely 19 years of age herself, borrowed a cell phone and called her village to talk with the child's father. He refused to provide consent for shortening fingers, so we operated to place skin grafts and make her large wounds into very small wound, knowing full well that she would develop severely deformed fingers and be highly disabled for life.
Harriet's injury was preventable, as are most burns of that nature, by adoption of a method of cooking safer than a pot perched precariously over a bonfire. For every disabling burn, 100 or more Zambian women are relentlessly damaging their health and that of their young children by chronically breathing the smoke from cooking fires.
One does not need to discover new scientific truths, develop magical new electronic devices, move from the reality of poverty to the fantasy-land of virtual reality. Simple tools built from common materials and plenty of footwork on the ground in rural parts of Africa will suffice to change the face of the future for millions of families across a continent.
We live in the present, informed by the past, but without an ability to
clearly see into the future. So we endow that unfocused view with our
hopes and dreams. Big dreams start with small steps. We have taken small steps, and are now about to take the first of some bigger steps. They are steps of hope, steps of faith, but grounded in the conviction that the work already done has proven the case, the relationships we have to work with are solid, with partners of integrity, already vetted through their demonstrated commitment to the welfare of their country and a long history of toil to that end.
Later this morning we met with our Zambian guests and transported them to InStoves workshop, where we showed them all the steps in producing an institutional cookstove. Our two founders, our talented young graduate school engineer, soon to finish his masters degree after studying the factors that contribute to the user experience in adapting to a new method of cooking using a high efficiency wood fired cookstoves. Yoram and Karen picked up parts and examined them, compared parts to complete stoves, asked questions and concluded that our methods are quite compatible with their understanding of Zambian industrial capacity. Karen was particularly impressed with the humble nature of our operations, reflecting that a prime organizational value of CHAZ is a humble heart.
We convened at InStove headquarters over hot tea and began exploring one another's motivation for seeking a conversation about partnership. We discovered an amazing alignment of mission and vision for making a measurable improvement in the lives of others, a growing confidence that our shared vision could be well supported by the products we produce that have already been placed with end-users. We explored the models of collaboration with which each organization has experience and learned that neither organization is skilled or experienced in testing and developing a market based model of technology transfer. We finished our morning session with a sense of alignment of mission and vision, but many questions about how one takes vision and converts it to policy, partnership and business practice.
We moved on to a simple soup and bread lunch, where a lively conversation over Zambian civil society, tribal life, geopolitical influence and view of progress and cultural change occurred. The conversation and laughter flowed. We then returned to Colgan's island and the warm conference room to complete the days deliberation. Yoram wrapped up the day with a summation of the opportunity, the needs of each partner and expressed a conviction about making a mutually persistent effort at finding our way. Specific methods and waypoints along the path to a full industrial scale partnership.
What a day of hope and inspiration! I pray that God's hand will be on us all as we seek ways to forward this work in spite of obstacles of time, money and forces of chaos arrayed against us in this world.
Saturday, March 9, 2019
Can I tell you a little story?
March 2019
So, ok, since you didn't say no...
In 2009 I found myself in the hinterlands of Zambia at a large mission hospital. Barbara Latenser, MD (may she rest in peace) asked me to sub for another surgeon on an eduational exchange mission under the flag of the American Burn Association International Outreach Committee. I hope to meet her again some day in another dimension; she is one of my life's heros.
Electricity at St. Francis Hospital was somewhat unreliable; if the lights went out during surgery, someone switched on a flash light. The hospital has a great big generator out in back, big GM 6-71 diesel unit on rails, sucked down 20 liters/hour; at about $10/liter, so it wasn't used all that often.
The kitchen is a primitive place; A great big darkened room from soot, down to your knees; huge pots perched over primitive clay stoves; just a big mud/ceramic combustion chambers with an open top and front, primitive flu out the back. Wood goes in as cord-wood, all day long. It takes some hours to heat the stove itself, so it makes sense to just keep feeding it, rather than start from scratch with a cold stove each meal. 360 patients, 200 nursing students, various and asundry other staff boarding over on the compound during their rotating assignments, all need to eat. One eats nshima (grits) as a staple, with one or another "relish" to garnish it, whether greens, fish, meat, tomato sauce.
Wood, truckloads of it, arrive to keep the fires burning. Tons of wood is delivered every other week or so. Medical sterilizing utilizes electric autoclaves, so one runs the autoclaves when the power was on, or used the generator if it fails.
At that facility I observed the sources of burn injury. Guys do what guys do the world over; lit things on fire. They get burned when the wind shifts as they burn off the chaff from their corn-fields to exterminate the rodents and snakes, when the petrol they use as an accelerant explodes, when they are drunk, working on their motorbikes/cars/trucks and not paying attention; you know, guy stuff.
Women and children, on the other hand, are injured almost exclusively around the cooking fire. Half the world cooks in open pots over open fires, pots perched precariously on 3 stones on the ground, big roaring fires, huge cauldons of simmering water with root vegetables, corn meal, whatever. Women of all ages cook in their long, flowing skirts (Chitengas in Zambia, Saris in India), generally the same dress with a different name, down to the ankle. infants are strapped to the hip, toddlers run un-checked through the cooking zone. So, clothes catch on fire, embers brand the skin, little curious hands tip over pots, wild young playmates trip and land in fires. These burns can be small, large, in between. They are almost always disfiguring, disabling or deadly due to lack of access to basic and expert care. I came home with observations; unreconciled, but I began to think and read about burns in poor countries, open fires, cooking, public health data and energy poverty.
In 2011, I returned to the same place, this time with a more mature view on which to build new observations. I had discovered an Oregon invention, the Rocket Stove. I bought a personal/family stove, checked it with my luggage. it arrived damaged, but still useable as a demo unit. Over 3 weeks of service, I observed more, thought more, read what I could with my rickety internet connection.
In late 2012, I made contact with Aprovecho Research Institute and Institutional Stove Solutions, co-located in Cottage Grove. January 2013, I attended Stove Camp. My life changed in a moment. I met amazing people, doing amazing things. Some became very important in my life. Fred, Lise, Tom, Jim, Nick and others. I also met Kirk, with Seeds of Hope International Partnerships, a NGO with US and Zambian divisions. 6 months later, I was on the ISS board of directors. I visited SoHIP in September 2013, while on a trip looking for a better location to establish a burn center of excellence.
Kirk had established a demonstration site for clean cookstoves at the SoHIP compound. I used my week in Ndola to cold-call multiple mission hospitals over the internet. God had His hand on this venture. The strongest lead came from Chitokolaki Mission Hospital in far NW Zambia. Gordon Hanna, the administrator, a Canadian missionary, responded. We shipped 4 stoves, 2 sterilizers through SoHIP, arriving in mid 2014.
We waited impatiently until January 2016 for feedback. It was stunning. The stoves, sterilizers performed fully to expectations, changed their energy usage dramatically while improving the users experience in cooking, sterilizing medical equipment. I committed to donating 10 stoves to the mission health organization, CHAZ on that basis. ISS found donors for sterilizers, we ended up shipping 16 stove/sterilizer combinations. They finally arrived in July 2017 and were distributed throughout Zambia over the following 6 months. I committed to $10,000 in stoves to CHAZ for 2018. ISS found donors for several autoclaves and the shipment went out in September.
It has taken forever, but it is about to arrive in Lusaka as I write. The challenge for CHAZ is to use this inventory to test a market model for distribution, using an existing microcredit program available to their 180-some-odd member organizations, mostly rural hospitals, health centers and clinics.
In the meantime, Institutional Stove Solutions has undergone a death/resurrection experience. The founder retired, the 501c3 closed and I purchased the factory contents to retire accounts payable. Nick Moses, the young engineer, opened Institutional Energy Solutions, and has inked a deal to build institutional stoves for Burn Manufacturing in Kenya. The next generation of ISS is alive and well.
I have a burden, placed on my heart, for the mission sector in Zambia. There is a similar sector in every country in Africa, many other parts of the world where the poorest countries on earth struggle to escape the bonds of poverty. Mission hospitals are ambassadors for everything good in rural parts of poor countries; education, literacy, wage-earning jobs in skilled occupations. The world uses biomass in large quantities to cook and heat dwellings. Problem is, they use it in highly inefficient ways that lead to deforestation, desertification, personal illness and injury, energy poverty. I see a pathway for introduction of high efficiency, affordable technology through the leadership of mission hospitals. Not only can the facilities and their workers directly benefit from clean, more efficient means to cook and sterilize, but they can become ambassadors in the communities they serve. This is my burden, my dream. It started with a career in burn surgery. It has morphed into a public health, environmental stewardship dream, and a fulfillment of a lifelong question about how someone like me, with no talent for preaching, could fulfill a missionary's dream.
God laid this vision out for me starting at age 49. He saw fit to allow my busy self-absorbed career as a burn surgeon slowly crumble before my eyes. He opened doors that I literally fell into, blind and backwards. He pried my eyes open and propped them open until I finally began to recognize what it was I was seeing.
I am approaching 59, and I see this as a part of my work to the end of the days He has in store for me. At the rate I can afford to do so, I will continue to sponsor stoves to Zambia, to mission health organizations, to feeding programs, to international disaster relief organizations, any pathway I can find to deliver appropriate technology to the most impoverished places on earth. I will continue connecting dots between technology, health care, people and places who can use one another.
It is a huge blessing to have a dream that is much bigger than what I can accomplish, what I can acquire and possess. One eventually learns that contentment in life revolves around what one can give, rather than what one can get and possess. Whether I impact a few or many others, the work will be a blessing to others and a blessing to me as well. What a gift!...do you have a dream that will carry you to the last day of your life?
Yes? then you are truly blessed. No? Walk with me a while, share this dream and see where the road takes you. Maybe you'll come to a fork in the road that takes you down a different path. Maybe we'll walk along together for a long time. I have known amazing fulfillment along this path and have been blessed to share it with others. There's more than enough to go around. You can drink from a deep well of satisfaction, knowing very deeply that real people are experiencing real transformation in their lives, health and work directly as a result of the work you do; we do; together. It starts with a conversation; Talk to me. Dream with me. nkemalyan@me.com 503-929-5219 cell/text
peace;
Nathan A. Kemalyan, MD
So, ok, since you didn't say no...
In 2009 I found myself in the hinterlands of Zambia at a large mission hospital. Barbara Latenser, MD (may she rest in peace) asked me to sub for another surgeon on an eduational exchange mission under the flag of the American Burn Association International Outreach Committee. I hope to meet her again some day in another dimension; she is one of my life's heros.
Electricity at St. Francis Hospital was somewhat unreliable; if the lights went out during surgery, someone switched on a flash light. The hospital has a great big generator out in back, big GM 6-71 diesel unit on rails, sucked down 20 liters/hour; at about $10/liter, so it wasn't used all that often.
The kitchen is a primitive place; A great big darkened room from soot, down to your knees; huge pots perched over primitive clay stoves; just a big mud/ceramic combustion chambers with an open top and front, primitive flu out the back. Wood goes in as cord-wood, all day long. It takes some hours to heat the stove itself, so it makes sense to just keep feeding it, rather than start from scratch with a cold stove each meal. 360 patients, 200 nursing students, various and asundry other staff boarding over on the compound during their rotating assignments, all need to eat. One eats nshima (grits) as a staple, with one or another "relish" to garnish it, whether greens, fish, meat, tomato sauce.
Wood, truckloads of it, arrive to keep the fires burning. Tons of wood is delivered every other week or so. Medical sterilizing utilizes electric autoclaves, so one runs the autoclaves when the power was on, or used the generator if it fails.
At that facility I observed the sources of burn injury. Guys do what guys do the world over; lit things on fire. They get burned when the wind shifts as they burn off the chaff from their corn-fields to exterminate the rodents and snakes, when the petrol they use as an accelerant explodes, when they are drunk, working on their motorbikes/cars/trucks and not paying attention; you know, guy stuff.
Women and children, on the other hand, are injured almost exclusively around the cooking fire. Half the world cooks in open pots over open fires, pots perched precariously on 3 stones on the ground, big roaring fires, huge cauldons of simmering water with root vegetables, corn meal, whatever. Women of all ages cook in their long, flowing skirts (Chitengas in Zambia, Saris in India), generally the same dress with a different name, down to the ankle. infants are strapped to the hip, toddlers run un-checked through the cooking zone. So, clothes catch on fire, embers brand the skin, little curious hands tip over pots, wild young playmates trip and land in fires. These burns can be small, large, in between. They are almost always disfiguring, disabling or deadly due to lack of access to basic and expert care. I came home with observations; unreconciled, but I began to think and read about burns in poor countries, open fires, cooking, public health data and energy poverty.
In 2011, I returned to the same place, this time with a more mature view on which to build new observations. I had discovered an Oregon invention, the Rocket Stove. I bought a personal/family stove, checked it with my luggage. it arrived damaged, but still useable as a demo unit. Over 3 weeks of service, I observed more, thought more, read what I could with my rickety internet connection.
In late 2012, I made contact with Aprovecho Research Institute and Institutional Stove Solutions, co-located in Cottage Grove. January 2013, I attended Stove Camp. My life changed in a moment. I met amazing people, doing amazing things. Some became very important in my life. Fred, Lise, Tom, Jim, Nick and others. I also met Kirk, with Seeds of Hope International Partnerships, a NGO with US and Zambian divisions. 6 months later, I was on the ISS board of directors. I visited SoHIP in September 2013, while on a trip looking for a better location to establish a burn center of excellence.
Kirk had established a demonstration site for clean cookstoves at the SoHIP compound. I used my week in Ndola to cold-call multiple mission hospitals over the internet. God had His hand on this venture. The strongest lead came from Chitokolaki Mission Hospital in far NW Zambia. Gordon Hanna, the administrator, a Canadian missionary, responded. We shipped 4 stoves, 2 sterilizers through SoHIP, arriving in mid 2014.
We waited impatiently until January 2016 for feedback. It was stunning. The stoves, sterilizers performed fully to expectations, changed their energy usage dramatically while improving the users experience in cooking, sterilizing medical equipment. I committed to donating 10 stoves to the mission health organization, CHAZ on that basis. ISS found donors for sterilizers, we ended up shipping 16 stove/sterilizer combinations. They finally arrived in July 2017 and were distributed throughout Zambia over the following 6 months. I committed to $10,000 in stoves to CHAZ for 2018. ISS found donors for several autoclaves and the shipment went out in September.
It has taken forever, but it is about to arrive in Lusaka as I write. The challenge for CHAZ is to use this inventory to test a market model for distribution, using an existing microcredit program available to their 180-some-odd member organizations, mostly rural hospitals, health centers and clinics.
In the meantime, Institutional Stove Solutions has undergone a death/resurrection experience. The founder retired, the 501c3 closed and I purchased the factory contents to retire accounts payable. Nick Moses, the young engineer, opened Institutional Energy Solutions, and has inked a deal to build institutional stoves for Burn Manufacturing in Kenya. The next generation of ISS is alive and well.
I have a burden, placed on my heart, for the mission sector in Zambia. There is a similar sector in every country in Africa, many other parts of the world where the poorest countries on earth struggle to escape the bonds of poverty. Mission hospitals are ambassadors for everything good in rural parts of poor countries; education, literacy, wage-earning jobs in skilled occupations. The world uses biomass in large quantities to cook and heat dwellings. Problem is, they use it in highly inefficient ways that lead to deforestation, desertification, personal illness and injury, energy poverty. I see a pathway for introduction of high efficiency, affordable technology through the leadership of mission hospitals. Not only can the facilities and their workers directly benefit from clean, more efficient means to cook and sterilize, but they can become ambassadors in the communities they serve. This is my burden, my dream. It started with a career in burn surgery. It has morphed into a public health, environmental stewardship dream, and a fulfillment of a lifelong question about how someone like me, with no talent for preaching, could fulfill a missionary's dream.
God laid this vision out for me starting at age 49. He saw fit to allow my busy self-absorbed career as a burn surgeon slowly crumble before my eyes. He opened doors that I literally fell into, blind and backwards. He pried my eyes open and propped them open until I finally began to recognize what it was I was seeing.
I am approaching 59, and I see this as a part of my work to the end of the days He has in store for me. At the rate I can afford to do so, I will continue to sponsor stoves to Zambia, to mission health organizations, to feeding programs, to international disaster relief organizations, any pathway I can find to deliver appropriate technology to the most impoverished places on earth. I will continue connecting dots between technology, health care, people and places who can use one another.
It is a huge blessing to have a dream that is much bigger than what I can accomplish, what I can acquire and possess. One eventually learns that contentment in life revolves around what one can give, rather than what one can get and possess. Whether I impact a few or many others, the work will be a blessing to others and a blessing to me as well. What a gift!...do you have a dream that will carry you to the last day of your life?
Yes? then you are truly blessed. No? Walk with me a while, share this dream and see where the road takes you. Maybe you'll come to a fork in the road that takes you down a different path. Maybe we'll walk along together for a long time. I have known amazing fulfillment along this path and have been blessed to share it with others. There's more than enough to go around. You can drink from a deep well of satisfaction, knowing very deeply that real people are experiencing real transformation in their lives, health and work directly as a result of the work you do; we do; together. It starts with a conversation; Talk to me. Dream with me. nkemalyan@me.com 503-929-5219 cell/text
peace;
Nathan A. Kemalyan, MD
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