Economic Meltdown and Teenage Boys

Whenever I turn on the radio or TV, I hear about how bad the economy is and how it’s only going to get worse. The unemployment rate keeps growing. The value of most people’s investments is falling. Most people’s homes are worth less than they were just a year ago. The price of gas for our cars goes up and down faster than the stock market. Trying to decide when to fill up my tank makes me feel like a futures speculator. “The price has been going up for the last two days. Is it going to go up more before I go home or will it go down by morning?” Making the wrong guess can cost me ten dollars per fill-up.

The people we are going to serve in Malawi don’t have to worry about the price of gas. They don’t have cars. However, the price of gas is reflected in things they buy, like school uniforms for their children, shoes, even the little bit of food that they don’t grow themselves.

When you live on less than a dollar a day and prices go up, where do you trim your budget?

Another phenomenon is watching my son Andrew sprouting like good Indiana corn. Every morning his pants ride higher up his ankles. For his after school snack, he eats his way through half the refrigerator, and then asks, “What’s for dinner?” If you are missing a child or small pet, you know where to look.

In places where there isn’t enough food, adolescent boys must always be hungry. In Africa, rice is food for the rich. Meat is a rare treat. How does a teen ager have a growth spurt on a diet of millet and corn mush?

Times are tough in the US and the whole developed world. In Africa, where people are living on the edge of survival, as the cliff starts to crumble there is only one place to go.

Even when we feel like we have nothing to share, Jesus asks us to share anyway. I think He might say, “You really have more than you think. Plus, real giving means giving up a little of what you need so that others can have something. Please share even when times are tough, maybe even more now that times are tough. Don’t worry. I really will take care of you.” (Luke 12:22-31)

I Miss Group Prayer

I’ve been in the US for three months now. Something that I miss terribly is daily group prayer. In Shell we prayed every day at the beginning of rounds, at the beginning and end of our weekly staff meeting and we had a weekly Men’s Bible Study.
Here at the secular university, we don’t do any of that. Except for a very few patients, like maybe once a week or less, I don’t get to pray with patients. I miss group prayer. Jesus says where two or three are gathered in His Name, He is there. I pray for patients, but it’s not the same as praying with them. I pray for students, residents and colleagues, but it’s not the same as praying with them. We have rounds to discuss the patients, but they don’t start with prayer. I miss beginning the right way, in the Name of Jesus, very much.
The university is treating very well. I love the work; taking young doctors at various ranges of training and helping them move to the next level is the best part of my day. I have the privilege of teaching very new doctors how to look in eyes and ears all the way to doctors about to graduate how to find a job and not get cheated on their contracts. I also see patients, which is what pays my salary. But my heart feels empty at times without the prayer.
I’m praying more with my wife, and we are in a small group at church that meets twice a week, but it’s not the same as every day prayer for our patients, for wisdom and compassion in treating our patients and their families.
I’ll just have to keep praying on my own to the Lord, and praying for more brothers and sisters in Christ to pray with.

Cultural Misunderstandings Can Happen in the US, Too

After a month working with the Family Practice residents at Indiana University, I have been happy to see that they are a group from all over the world; South Asia, East Asia, Latin America and Africa. They all really like each other and are all likable people.
For these young doctors, their second or third language is English and they speak English with each other, but they also communicate well in laughter and love. I see the new residents liking each other. It’s rewarding to hear the Pakistani resident learning to say good morning in Spanish so that she can greet her classmates from Honduras and Colombia. It is even more rewarding to see the residents starting their second year really love each other and laugh at their war stories like old soldiers. They are young doctors who know how much they have to learn, are dedicated to becoming excellent doctors and are caring people. It’s really a great group.
The hardest part of the hiring process must be finding truly caring people in a one day interview. Many people can fake being a nice person for a day or two, but by judging the results, IU seems to have separated the wheat from the chaff. I saw the difficulty while interviewing residents at the University of Arizona and in Ecuador, so I appreciate how much wisdom is involved in picking this group of residents. It’s a testament to the discernment of the people involved in the process and people who refined the interview process.
Just this morning I saw that cultural misunderstandings can happen anywhere, and can be embarrassing, no matter where you are. In Ecuador and much of Latin America, it is considered highly rude to walk between two people talking. It’s easier to avoid walking between people because Ecuadorians stand closer to each other than Americans.
This morning, I was walking down the hall. Three people were talking, one of them a resident from Pakistan. Seeing a small, brown person in a conversation, I kept making little steps to try to go behind her so that I wouldn’t walk through a conversation. Apparently, in Pakistan, walking through a group that is talking is not a big deal, so she kept making small little mincing steps to allow me to go through the group, not around it. We went through this little dance for about 15 seconds, then I finally remembered that this resident, although small and dark skinned, was not from Ecuador. I needed my second cup of coffee to get my brain out of first gear.
It’s a small thing, my little embarrassment this morning. I’m not even sure the resident would remember any of it, but I remember that I am out of the culture loop after five years overseas. My children are really out of the loop, since their last time living in the USA was almost half their lives ago. I personally love learning about the little things of other cultures, except for when I make a total fool of myself. I don’t even need to be in another culture to make a fool of myself, but it’s a convenient excuse.
When you’re on the mission field, if you haven’t made a fool of yourself at least once a day, it’s because you didn’t leave the yard.
Your ego, try to leave home without it.

What I'm looking forward to in the US

As much as I’ve loved my time here in Ecuador, I am looking forward to some things in the US. Here’s an incomplete list of what I’m looking forward to in the US:

• Electric lights that turn on every time you flip the switch.
• Toilets that flush every time you push the handle.
• Not having the fear that I will go to jail for a little fender-bender. Here, everyone in or near the accident goes to jail until the judge sorts it out.
• Public restrooms that are clean and have toilet paper.
• Not having the fear that any time you get in a vehicle it could be your last look at Earth. (The drivers here love to pass on 2 lane bridges, blind curves, and going up hills.)
• Pretzels. (There is every kind of junk food available, even Sour Cream and Onion Ruffles, but no pretzels.)
• Diet Dr. Pepper (You can’t even get regular Dr. Pepper here.)
• Tunnels that you can see in, because they have lights.
• The power is on always.
• Not having to change the propane gas tank on the hot water heater to get a warm shower.
• Drinking the water.
• Newspapers and books in English.
• News in English on the radio.
• Autumn leaves.
• Seeing as many of you as possible.

See you soon.
Blessings,
Jerry

Things I'll Miss about Shell, Hospital Vozandes and Ecuador

• · Everything within walking distance.
• · Living across the street from the hospital.
• · Getting into a car maybe once a week or less.
• · Little kiosks where you can interact with a human when you buy something.
• · Serving the very poor.
• · Shaking hands with everyone you meet.
• · Saying hello to everyone every morning and again in the afternoon.
• · So little car traffic that you can walk or jog in the middle of the street.
• · The big crime wave: some lawn chairs stolen from a porch.
• · $1 lunch, $1.30 if you go to the expensive place.
• · Knowing most everyone I deal with daily.
• · Praying at the start of every work day and whenever a patient has a crisis.
• · NO INSURANCE FORMS
• · No malpractice claims, lawyers, or threats.

Born on Third Base

If life were a baseball game, I was born on third base. There's nothing wrong with being born on third base, unless I become proud and think that I got to third base through my own efforts. Honestly, anyone who is reading this was probably born on third base, also.

For those of you who don’t know baseball, think of football (soccer) as being born getting to kick a penalty kick with no goalie trying to block the shot. It’s not a guarantee you’ll make a goal, but the odds don’t get much better.

Why do I say I was born on third base? My parents could read and taught me to read. I was born in the US, where free public education is really free. In some of the countries I have visited, "free public education" means you have to pay for uniforms, buy new textbooks every year, pay special "fees" for the teacher, computers, and miscellaneous rip offs. In the US, public education is really free and quite good.

Why else was I born on third base? Despite claims of reverse discrimination against white males, white males in the US have lots of advantages. Some people are not fond of the US at this point in time, but having a US passport gives lots of advantages throughout the world. When I go to get my Driver's License here, I don't have to pay a bribe like my national friends. Why no bribe? I have a blue passport form the USA.

I could easily have born to a family in the jungle, where my parents could not read and there are no schools, where a man has to kill or be killed, where girls are married off after their first menstrual period. (I really have delivered a baby from a 12-year-old girl from the jungle.) I could have learned a language that is only spoken in a handful of villages and precludes me from getting a job in the money economy. Those are people are born at bat standing at home plate.

For those of you following the football (soccer) analogy, jungle folk were born at the far end of the field, all by themselves, with all eleven players from the other team trying to stop them from scoring a goal. It’s not definite that they won’t make it, but it’s not likely.

I have a friend who was born in Africa to Indian parents. However, both his parents were teachers, taught him to read, instilled in him a love of education and passed on their intelligence genes as well. He didn’t have his mental development destroyed by malaria, malnutrition or military actions. My Indian/African friend was born on second base. (For you soccer fans, that’s a little outside the penalty area.)

So now that we all realize that we were born with multiple privileges… (What? You’re still not convinced?) You have access to a computer. You learned to read from your parents. You aren’t in prison or trying to survive from day to day like the folks in Zimbabwe or the rest of Africa. You can see so that you can read. You have hands that can manipulate a computer mouse. Yes, you have made the most of the opportunities God blessed you with, but you didn’t earn those blessings.

We’ll try again. Now that we all agree that we have blessings we didn’t earn, what do with do with that knowledge? I can’t tell you what God wants you to do with the gifts He has given you, but I can make a couple of suggestions:

• Share. You can share the money you make from what you do with your gifts or you can take the gifts on the road to share them with people who don’t have ready access to those gifts.
• Thank God for the gifts. If you didn’t earn gifts, you can thank the Giver daily for them.
• Avoid pride. If you could just as easily have been born to live you days barefoot in the jungle, don’t feel so smug. Really believe the phrase, “there but for the grace of God go I.”
• Share regularly. If you have money in the bank, or even loose change in your pocket, you are richer than 80% of the people in the world, so share some of that blessing every pay day. Kind of like a tithe. I know we live under the New Covenant, but tithing is one of the best ideas the Old Testament has to offer. God doesn’t need your money, but you need to give it to Him.

So now that we are all on third base, let’s get home well. Now that we are kicking to an open goal, let’s score. God is on His feet, in the stands cheering for us.

Blessings,

Jerry

What I Will Miss about Shell

You can walk on the street anytime before midnight and feel safe.

The kids can walk to their friends’ houses safely.

After 50 years of missionary presence, there is a lot of kindness and care in Shell.

The hospital really makes a difference. People come from very far because we treat them well and give good medical care.

I have patients who are good friends.

The weather is great.

The fruits and juices are wonderful.

Beautiful birds.

I can pray openly with patients.

We start every day with group prayer.

The medical students and residents are eager to learn.

The missionaries.

Getting a front row seat to see God’s miracles.

No TV, no X-boxes, and no weapons in neighbors’ houses.

The children’s friends’ parents share our values and standards.

We will miss Shell a lot.

Blessings,
Jerry

Big Urine, Little Urine

In Ecuador, especially among indigenous people, big urine is stool, and little urine (la orina chiquita, la orina pequeña) is urine. When people complain of problems urinating, the doctor has to be sure to specify which one.

Humorous story to remember this by: One doctor had an elderly gentleman who came in repeatedly saying, “I can’t urinate.”

The doctor gave him Hytrin, a medicine to help men with prostate trouble pee. He still couldn’t go. Finally, the doctor took him to the Emergency Room to put a Foley catheter in him. He starts to scream, “NO! I just can’t pee!”

The doctor remembered big urine vs. little urine and asked how many days since the gentleman pooped. It had been about 4 days. Milk of Magnesia cured him when a Foley catheter put into his bladder couldn’t.

A Grizzly Day by Mike Hardin, MD

Do you ever wonder if all your life’s training was to prepare you for one moment? In retrospect, Saturday, January 19, 2008 seems like that day.

The setting is our 30-bed mission hospital with a two and a half bed E.R., running on generator power since the electricity was out to our section of the country, with one doctor, one resident, one intern and two nurses on duty on a Saturday morning. At 10:15 AM a bus crashes and overturns on the road winding down from the Andes towards the Amazon, about a 25-minute drive from the hospital.

Six are dead on the scene. Bystanders begin loading other victims into pickup trucks, cars and eventually ambulances to be transported down the road to our hospital or up the road to others.

As soon as we realized the number of wounded arriving (eventually 23), we enacted the finely tuned hospital disaster plan: call everyone related to the hospital and then some and ask them to come help. The hospital ambulance trolled through town to find employees and bring them in.

Broken and bloody body after body came through the door and were placed on stretchers or benches in the hallway. It resembled a scene from a war movie. The amount of blood and gravity of the injuries were overwhelming. We made quick triage decisions as we decided one victim was too far gone to save – we stopped resuscitation and pushed the body to the end of the hallway to free up space for others that could be saved. The number of critical patients quickly outnumbered our medical personnel.

Four with severe head injuries were intubated and placed on our three ventilators. Short one ventilator, a patient’s mother-in-law was quickly briefed on how to keep her son-in-law alive by squeezing the ambu bag and ventilating him while we moved on to other patients. She kept it up for two hours before he was transferred.

Victims were labeled with tags with numbers and brief exam findings. Only later were people identified. Some of the injured had to identify their severely wounded or dead relatives for us.

One scene still plays in my head. A 21-year old Korean American girl wandering through the E.R. door with the entire right side of her face from her nose to her ear hanging off, exposing her skull, the skin held up by her right hand. A missionary took her off for treatment.

Everyone came to help. All of the missionary doctors, various spouses -- even the kitchen, janitorial, maintenance and administrative staff of the hospital were all enlisted in some way. Our administrator’s wife found herself shaving and prepping victims’ heads for suturing. Missionaries and staff donated blood that was immediately transfused into patients -- the closest blood bank was unable to process blood due to the power outage.

A call for help to the nearest hospital brought another five Ecuadorian doctors, among them a much needed orthopedist and general surgeon plus two radiology techs to help with the numerous x-rays.

In all, two patients died, six critical head injury patients were transferred for CT evaluation, several underwent major surgery for internal bleeding or extensive suturing and the remainder had lacerations sutured and fractures splinted or casted.

There were numerous heart-wrenching stories. An injured mother with a one-month old baby identifying her dead husband, her four nephews and nieces severely injured as well, their own mother later found dead at another hospital 45 minutes away. Another mother with her severely injured five-year old son at our hospital, her daughter in another hospital and her husband in even another one two hours away undergoing neurosurgery to remove blood clots from his brain. The American girl, severely disfigured, far from home and alone, in such shock she could only worry about her missing backpack that contained all her research data for her graduate thesis.

And there were bright spots. The incredible spirit of teamwork in a gruesome situation, the accidental transfer of anonymous patients (who ended up being related) to the same hospital, gravely injured patients whose lives were saved. I’m proud of a dedicated staff that freely gave their all to help in a horrendous situation.

The following day we airlifted seven more patients (paid for by the local ministry of health, a miracle in itself) to other hospitals for further treatment and discharged the least of the wounded, an 80-year old woman with a small cut on her forehead.

Missionaries contacted the relatives of the American girl, notified the U.S. Embassy, made lodging and transportation arrangements for the family, arranged for her transfer to a Quito hospital and welcomed her there with hospital visits by English-speakers. Another very determined missionary traveled to two separate towns, three different police stations and the regional transportation office in search of the backpack. She even searched the wreckage of the entire bus and found nothing. Eventually, in a locked storeroom in a ministry of transportation office in a town two hours away she found the backpack, still sealed with all the girl’s research data, cash, credit cards and passport. It arrived in Quito today.

I’m not sure how to end except to ask for your prayers for the numerous victims and their grieving families and for a shocked hospital staff that experienced a lot more than they ever bargained for.