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
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