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The Adventures of a Young Hospital CEO

Paul Howe is a hospital CEO. It may be fair to say that he is the only hospital CEO anywhere who graduated from law school this year. Instead of going to work for a big law firm after getting his degree from Washington and Lee, Howe headed to Gimbie Adventist Hospital in Ethiopia. He is 25.
Question: Did you ever think you would be CEO of a 71-bed hospital in Ethiopia? What led to you getting the position?

I like having options and I never plan too far ahead. God leads me one step at a time.
I take the opportunities that I think will open the most doors.
My grandfather started Brooke Grove Foundation, a nursing home assisted living corporation in Silver Spring, Maryland, and I often considered working there, so healthcare administration was always somewhere in the back of my mind.
My dad is an Internist. Our family spent three months in Nepal in 1998 manning a remote clinic. I installed solar panels and lighting systems.
Royal forces controlled our area by day and communists controlled it at night. I got to watch my dad negotiate with both sides. I wasn’t that interested in the medical side of things, but I was fascinated by the political and employment angles. These interests eventually led me to law school, where I focused on negotiation and mediation.
I married Petra Houmann in 2007 after my second year of law school. She comes from a long line of medical missionaries. Petra’s grandfather was Haile Selassie’s personal physician and her dad grew up in Ethiopia. She and her family were in Rwanda during the 1994 genocide and later served as missionaries in Malawi.
I spent the summer after we got married at a large law firm. I felt like I was selling my soul. Petra encouraged me to explore non-legal job options.
Dick Hart (Loma Linda University and Adventist Health International president) was a former neighbor and family friend. I heard he needed someone in Afghanistan so I called him up. Afghanistan wasn’t an option, but Dick offered me the job at Gimbie in Ethiopia and I took it.

Question: How long have you been at the hospital and how long do you intend to stay? What does Petra do at the hospital?

Answer: We have been here about two months. We agreed to stay for two years, but I am open to staying for longer. We’ll see. I really enjoy this job.
Petra serves as volunteer coordinator for the hospital and associated clinics.
I manage seven clinics and a nursing school in addition to the hospital and am country director for Adventist Health International.
Question: Does Gimbie have Adventist staff? Adventist patients?
Answer: Gimbie Adventist Hospital is owned by the Union and is managed by Adventist Health International, a Loma Linda-based nonprofit. About two-thirds of the staff are Adventists. Most of the patients are not.
We partner with a number of other organizations worldwide and a group of local Catholic nuns.
Question: What are the doctors and nurses that you work with like?
Answer: Most of the doctors and nurses are Ethiopians. The hospital is very remote and many of them would rather work in the city.
Our hospital is known for training staff, so they often come here straight out of school and leave as soon as they get experience.
However, we do have a number of long-standing employees—folks who have been here for 20+ years and are committed to staying, come hell or high water. These people form the backbone of the hospital. They are highly skilled and could get better paying jobs elsewhere, but they value SDA medical mission work and decided to focus on building up treasure in heaven.
We have some expat volunteer nurses and MDs, usually short term volunteers.
We are currently experiencing a critical staffing shortage. About 75% of Ethiopian MDs and nurses work outside of Ethiopia. The remaining 25% are disappearing like butter in a fire. Those who choose to stay demand impossibly high salaries.
Traditional wisdom suggests that Ethiopians should stay to help their country. However, most Ethiopian medical professionals were educated with family funds. Once they graduate they are expected to support a large extended family. This is obviously easier to do from the US than from Ethiopia. The brain drain is crippling.
I think it is time for the developed nations to help Africa by sending human resources, not cash. We live in a globalized world and can’t expect Africans to stay put. I think healthcare quality will regress without outside help.
Question: What kind of patients does the hospital treat?
Answer: A wide variety. Some things we treat include TB, typhoid, hookworm, HIV, malnutrition and dehydration, syphilis, pneumonia, and wounds and trauma.

Question: What are the main challenges the hospital faces?

Answer: Lack of funds. Between the international economic downturn and the national famine, Ethiopia is really struggling. There has been a large spike in prices for food, fuel, and building materials. Inflation is
rising rapidly.
Lack of qualified staff is another challenge. Many educated Ethiopians immigrate to the US or other developed countries.
There is a General Conference budget for an expat surgeon. I
am currently recruiting for this position. We could also use nurses and midwives. Volunteers of all kinds are always welcome.
Lack of equipment is also a challenge. We need to ship in some critical equipment.
Question: Can you take us through a typical day for you?
Answer: I wrote a detailed account of a typical day on my blog at
It starts with:
2:30 a.m. Wake up and find water is on for the first time in three days. Take a shower and fill every bucket in the house. Go back to sleep.
Question: Where do you live?
Answer: We live in a spacious house built by the Italians around 1935. It is falling apart from lack of maintenance. The house is on the hospital grounds, next to the morgue.
The hospital is at about 6,800 feet, so the weather is much more temperate than in other parts of the country. We are not far from the Sudanese border.
Question: You don’t have a medical background. Is that a problem? What are the main skills you need in your position?
Answer: I do not have medical training, but I grew up in a medical family and am familiar with medical issues.
There are some days when I wish I could help out with emergency C sections and such, but I have enough to do without being personally involved in providing medical care.
I spend most of my time negotiating. This involves agreements with other NGOs, government bodies, employees, potential employees, former employees, church leaders, etc. I have always enjoyed working with difficult people and resolving thorny issues. My law school training is invaluable in this regard.
Ethiopia has a number of distinct people groups and at any one time we are likely to have representatives of at least five other countries.
Thus much of my work involves intercultural communication. I have traveled to about 30 countries so I have some experience in this area.
Petra is probably a better intercultural communicator than I am (she speaks five languages) and she helps me a great deal.
Question: Give us a little background on yourself and on your education and experience.
Answer: I homeschooled until college. This gave me time to tour with the New England Youth Ensemble, serve as crew for international yacht deliveries, and do a ton of backpacking and whitewater canoeing. I was also involved in fundraising and construction of an AIDS orphanage in Zimbabwe.
At Columbia Union College I majored in history. I think I took every course that Doug Morgan and Roy Branson offered. The New England Youth Ensemble was a regular part of life, although I spent more time managing than playing viola. I also worked with James Standish, the SDA point man on Capital Hill.
I took the LSAT during the summer of my junior year. Washington and Lee offered me a good scholarship and I jumped at the chance to get a graduate degree debt-free. I still wasn’t sure about being a lawyer, but I figured a JD was versatile enough that I could do just about anything when I graduated. I finished law school this year.

Question: What do you intend to do after you leave Ethiopia?

Answer: I have lots of options. I enjoy healthcare administration and I might build a career in that line.
My wife would be happy if we spent the rest of our lives abroad. I passed the Foreign Service exam, so I could work for the State Department.
Several law firms would like me to work for them after I finish here.
And I have always wanted to get a PhD in some branch of

Question: Ethiopia has been back in the news recently, with stories of further starvation and famine. Have you seen evidence of that where you are?

Answer: The famine is mostly south of us, but food is prices have risen dramatically. Many of our staff are barely getting by. If the famine gets much worse we will be hit hard.
The political situation is unstable but not violent.

Question: What do you miss about home?

The ocean, rivers, and lakes. I’m a sailor and I love fresh water swimming. Geography and disease put many of my favorite activities off-limits. I am sure that I will miss snow.
Ethiopian food is excellent. I can’t say I’ve missed home cooking.
Question: What have you seen about the way the Adventist church works in the developing world? What is the church doing right, in your opinion? What could it do better?
Answer: The SDA church in Ethiopia is doing a good job of soul winning. Church books are filling up. Unfortunately, membership does not necessarily equal change of heart.
In the US, squabbles over church employment are a matter of status. Here they may mean the difference between plenty and starvation. Not surprisingly, Ethiopia’s church politics are sometimes raw and bitter. Ethiopian SDAs aren’t more grasping than their US or UK counterparts, but they don’t have the financial padding which provides civility in the first world.
The focus on soul winning sometimes means that community involvement takes a distant second. Prior administrators have had conflicts with the local SDA church. I think that this is partly because the hospital did not express any interest in soul winning.
In my view, solving people’s physical needs is laudable, but neglecting their spiritual needs in the healthcare setting is as foolish as bandaging a paper cut while sitting on a ticking time bomb.
So far, I have involved the hospital in spiritual activities. The church has responded by providing physical help. I preach and help with the choir. The church gives us free labor. They gave us a free building when one of our clinics burned down.
Basically, the developing world needs help. First world Adventism is splintered. Unity of action is limited to nonexistent. This may be the best way to meet the diverse spiritual needs of the first world.
However, the third world doesn’t have such luxury. Unity of action is the only way to meet Ethiopia’s vast physical and spiritual needs. The church in Ethiopia needs to pull together. Unity should be more of a priority.
Question: What are the major things you have learned in your time there so far?
Answer: Ethiopian culture is rich and deep. I have learned to navigate its basic tenets, but true understanding would take a lifetime.
I have learned that Ethiopia’s needs are far more desperate and gripping than anything I saw on the news. Many people feel that development is moving in reverse.
Being CEO of Gimbie Hospital often feels like living under the sword of Damocles. I am learning to deal with huge amounts of stress.

Keep up with Paul Howe’s adventures via his blog at

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