We are famous. We are on another web site, to prove that we exist in cyberspace, which doesn't really exist. I'm so confused that I exist in a place which doesn't exist, but it's true.
See you.
Wednesday, September 28, 2011
Tuesday, August 30, 2011
One Slightly Odd Sunday in Africa
A new adventure in Malawi:
Elizabeth's purse is stolen at lunch. We were upset. Our friends suggest we pray.
We prayed.
After Elizabeth canceled all her credit cards by skype, a friend calls. Her name is Amanda, the first name on Elizabeth's phone. The central police station called Amanda saying that Elizabeth's purse had been recovered. We celebrate, but know that the $100 cash is gone, but hope the credit cards and license are still there.
We get to the station, and see the purse on the desk. The police woman says it was found in the bathroom with a note inside saying it was "found" at the restaurant where it was stolen.
No cell phone, but the credit cards and license are there.
I call the cell phone. A man answers. I say that we're at the police station. He answers that the purse is in the bathroom. He says that we will find her car keys, her documents, "and everything."
Now I know who put it in the bathroom, the guy who answered my wife's phone.
I ask, "OK, can we have the phone back, too, please?" I actually said "please" to a thief.
He answers, slowly, "OK" then CLICK.
So I sent the guy a text, to my wife's phone, "Thanks for returning the purse. We will pray for you to stop sinning. We forgive you. God loves you."
I couldn't fit in one text, " I'm glad you have half a conscience, but I hope you regrow the lost half, because if you aren't careful you will lose both halves permanently."
We go back to the scene of the crime, a longer story, and just for the heck of it I call the phone, hoping to hear a guilty cell phone, but since this is not a movie, the cell phone is turned off and no guilty ring.
T I A this is Africa
Elizabeth's purse is stolen at lunch. We were upset. Our friends suggest we pray.
We prayed.
After Elizabeth canceled all her credit cards by skype, a friend calls. Her name is Amanda, the first name on Elizabeth's phone. The central police station called Amanda saying that Elizabeth's purse had been recovered. We celebrate, but know that the $100 cash is gone, but hope the credit cards and license are still there.
We get to the station, and see the purse on the desk. The police woman says it was found in the bathroom with a note inside saying it was "found" at the restaurant where it was stolen.
No cell phone, but the credit cards and license are there.
I call the cell phone. A man answers. I say that we're at the police station. He answers that the purse is in the bathroom. He says that we will find her car keys, her documents, "and everything."
Now I know who put it in the bathroom, the guy who answered my wife's phone.
I ask, "OK, can we have the phone back, too, please?" I actually said "please" to a thief.
He answers, slowly, "OK" then CLICK.
So I sent the guy a text, to my wife's phone, "Thanks for returning the purse. We will pray for you to stop sinning. We forgive you. God loves you."
I couldn't fit in one text, " I'm glad you have half a conscience, but I hope you regrow the lost half, because if you aren't careful you will lose both halves permanently."
We go back to the scene of the crime, a longer story, and just for the heck of it I call the phone, hoping to hear a guilty cell phone, but since this is not a movie, the cell phone is turned off and no guilty ring.
T I A this is Africa
Thursday, August 18, 2011
What Should I Specialize In to be a Medical Missionary
What Should I Specialize In?
I used to think that the only useful specialties for the medical missionary were Family Medicine and General Surgery. My ideas have broadened a bit since I have had some real experience on the mission field.
One area I never thought of was Anesthesiology. Without an Anesthesiologist the surgeon is extremely limited in what he or she can do. They are limited to minor procedures or trying to put the patient to sleep, and more importantly, wake her up again, all alone. Additionally, since the anesthesiologist put people on ventilators all the time, she is the doctor best prepared to manage patients on a ventilator in the Intensive Care Unit. One or two patients in the Intensive Care Unit can keep an anesthesiologist without a good night’s sleep for a week.
In general, the broader the training, the better one is prepared to be a missionary physician. The three most useful specialties in my mind are Family Medicine, General Surgery and Anesthesiology. In my opinion, combined Internal Medicine/ Pediatrics is a close fourth, followed by Internal Medicine or Pediatrics alone. In Shell, until we had a Pediatrician who cared for hospital patients, the Family Practice doctors were caring for sick Newborns. All we had to work with was two weeks of NICU training in residency and the Harriet Lane Handbook. We were practicing way over our heads, but most of our patients did alright because the handbooks were well written and God was gracious.
There is a role for specialists and sub specialists, but that’s mostly in teaching in short term stints in the large medical centers in a country. The Christian Medical and Dental Associations and medical schools regularly have groups that go to developing countries to teach local specialists at the big medical centers. The specialists will teach new procedures or do an update on information to the national specialists.
Another place for specialists in developing countries is on one to two week medical brigades. Long term missionaries able to treat most anything that walks through the door, which means a generalist who is able to find information or know where to send a patient is best equipped to greet the patient at the door. The problem is than when a specialist is needed, one specific specialist is needed for one patient right now, not in four months when the brigade is coming.
In Ecuador every year a group of Ear, Nose and Throat surgeons from Operation Hope would come for a two week intensive caravan to repair cleft lips, cleft palates and ears that never grew. They did a lot of great work, but they were US doctors fifty weeks a year and US doctors who worked overseas two weeks a year. They would take an entire crew of surgeons, anesthesiologists, nurses, translators and helpers. The only part of third world medicine these doctors experienced was the beds the patients used post-operatively. I was always grateful to Operation Hope, but I also knew they would be gone for fifty weeks once they left.
I took a group of children from the jungle to the Operation Hope Brigade every year. I would translate for the doctors and bring them my patients. The surgeons would teach me about what they were doing, what criteria they would use to make their decisions and how they would do their miraculous surgeries, and let me bring my patients to the front of the line. The more they taught me, the more I could prescreen patients for them and make their time more efficient. They did a great work but they weren’t International Doctors in the way I want to be, but my patients and I were very grateful for their work.
I used to think that the only useful specialties for the medical missionary were Family Medicine and General Surgery. My ideas have broadened a bit since I have had some real experience on the mission field.
One area I never thought of was Anesthesiology. Without an Anesthesiologist the surgeon is extremely limited in what he or she can do. They are limited to minor procedures or trying to put the patient to sleep, and more importantly, wake her up again, all alone. Additionally, since the anesthesiologist put people on ventilators all the time, she is the doctor best prepared to manage patients on a ventilator in the Intensive Care Unit. One or two patients in the Intensive Care Unit can keep an anesthesiologist without a good night’s sleep for a week.
In general, the broader the training, the better one is prepared to be a missionary physician. The three most useful specialties in my mind are Family Medicine, General Surgery and Anesthesiology. In my opinion, combined Internal Medicine/ Pediatrics is a close fourth, followed by Internal Medicine or Pediatrics alone. In Shell, until we had a Pediatrician who cared for hospital patients, the Family Practice doctors were caring for sick Newborns. All we had to work with was two weeks of NICU training in residency and the Harriet Lane Handbook. We were practicing way over our heads, but most of our patients did alright because the handbooks were well written and God was gracious.
There is a role for specialists and sub specialists, but that’s mostly in teaching in short term stints in the large medical centers in a country. The Christian Medical and Dental Associations and medical schools regularly have groups that go to developing countries to teach local specialists at the big medical centers. The specialists will teach new procedures or do an update on information to the national specialists.
Another place for specialists in developing countries is on one to two week medical brigades. Long term missionaries able to treat most anything that walks through the door, which means a generalist who is able to find information or know where to send a patient is best equipped to greet the patient at the door. The problem is than when a specialist is needed, one specific specialist is needed for one patient right now, not in four months when the brigade is coming.
In Ecuador every year a group of Ear, Nose and Throat surgeons from Operation Hope would come for a two week intensive caravan to repair cleft lips, cleft palates and ears that never grew. They did a lot of great work, but they were US doctors fifty weeks a year and US doctors who worked overseas two weeks a year. They would take an entire crew of surgeons, anesthesiologists, nurses, translators and helpers. The only part of third world medicine these doctors experienced was the beds the patients used post-operatively. I was always grateful to Operation Hope, but I also knew they would be gone for fifty weeks once they left.
I took a group of children from the jungle to the Operation Hope Brigade every year. I would translate for the doctors and bring them my patients. The surgeons would teach me about what they were doing, what criteria they would use to make their decisions and how they would do their miraculous surgeries, and let me bring my patients to the front of the line. The more they taught me, the more I could prescreen patients for them and make their time more efficient. They did a great work but they weren’t International Doctors in the way I want to be, but my patients and I were very grateful for their work.
Monday, July 11, 2011
What Else I Thought I Needed to Know
Section 3
Before I actually worked overseas, I also thought I needed to know how to do a lot of procedures. There are a number of procedures one can do one the field, but I learned that it’s best to learn on the equipment one has on hand in the field.
In Ecuador, our gastroscope (the scope for looking into stomachs) was incredibly old. It didn’t have a TV camera like scopes in any US hospital. We looked through a tiny window the size of a microscope eye piece. It didn’t even have air insufflation, the part that blows up the stomach so the doctor can see what’s in there. We had to blow air down the suction port of the scope with a nebulizer, one of the breathing machines used for an asthma attack. Any amount of training with state of the art equipment in the developed world would have been just about worthless with our barely functional scope. Learning on the job with the equipment on hand was the best way to learn.
Before I actually worked overseas, I also thought I needed to know how to do a lot of procedures. There are a number of procedures one can do one the field, but I learned that it’s best to learn on the equipment one has on hand in the field.
In Ecuador, our gastroscope (the scope for looking into stomachs) was incredibly old. It didn’t have a TV camera like scopes in any US hospital. We looked through a tiny window the size of a microscope eye piece. It didn’t even have air insufflation, the part that blows up the stomach so the doctor can see what’s in there. We had to blow air down the suction port of the scope with a nebulizer, one of the breathing machines used for an asthma attack. Any amount of training with state of the art equipment in the developed world would have been just about worthless with our barely functional scope. Learning on the job with the equipment on hand was the best way to learn.
Sunday, June 12, 2011
What I Thought I Needed to Know
Section 2
When I was a fourth year medical student planning to do medical missions, I thought I needed to know how to do everything, especially every surgical procedure known to humankind. I thought, and have since heard many medical students say, “I want to know how to do an appendectomy in case I need to do it.” I actually thought that the best international doctor could do an appendectomy with one hand while doing a Caesarian section with the other hand.
I was not the first medical student to think I needed to be an expert in surgery, obstetrics and family medicine to be an effective medical missionary. One interview at Marshall University International Health Residency went like this:
Experienced International Doctor: “So, you want to do International Medicine?”
Me: “Yes, sir. Very much!”
Experienced Doctor: “I suppose that you think you need to learn Surgery and Obstetrics?”
Me: “Oh yes, sir! I need to know how in case there is no one else around who can do the surgery.”
Experienced Doctor: “Wrong! You should only do Surgery and OB if you like doing them.”
His point was that if you do what you love and feel comfortable with, you will be a better International Doctor. In Ecuador, when the patient needed a Caesarian Section, we called in the surgeon. Since the surgeon was more experienced at cutting and sewing, he took the baby out and sewed the patient back up. He was the best person for the job, and the Family Practice doctors were better at receiving the baby and doing neonatal resuscitation when it was necessary. So the Family Doctor would decide when a C/section was necessary, but the Surgeon would do the work.
In Ecuador, we had surgeons and anesthesiologists. In Malawi, we don’t have surgeons, we don’t have anesthesiologists and we don’t have an operating room. There are other hospitals with all of those within an hour’s drive, both missionary and government hospitals. They have the personnel and equipment to do surgeries properly.
A doctor who is unpracticed in what he’s doing combined with lack of facilities and staff members who don’t know what they are doing is a real recipe for hurting someone. Having a plan in place for what to do if a surgical patient walks in the door is much better than trying a surgery you have not done in years. Of course, in dire emergency, with no other options, trying a surgery may the best option, but exploring all the other options first is vital.
Another issue is that a surgeon is only as good as the anesthesiologist working with him or her. There’s a reason that anesthesiology is a four year residency, there’s a lot to learn. Putting someone to sleep and waking them up again looks easy because anesthesiologists are really good at what they do and they have trained a long time. Anesthesia and surgery are not places for amateurs.
So unless the doctor is cut off from any other resources for many days, knowing where the best available surgeons and anesthesiologists are is far better for the patient than attempting a procedure you have never done. Patients often can be stabilized and moved to a proper facility in about the same time that it takes to find all of the instruments when the doctor and the staff rarely use them.
When I was a fourth year medical student planning to do medical missions, I thought I needed to know how to do everything, especially every surgical procedure known to humankind. I thought, and have since heard many medical students say, “I want to know how to do an appendectomy in case I need to do it.” I actually thought that the best international doctor could do an appendectomy with one hand while doing a Caesarian section with the other hand.
I was not the first medical student to think I needed to be an expert in surgery, obstetrics and family medicine to be an effective medical missionary. One interview at Marshall University International Health Residency went like this:
Experienced International Doctor: “So, you want to do International Medicine?”
Me: “Yes, sir. Very much!”
Experienced Doctor: “I suppose that you think you need to learn Surgery and Obstetrics?”
Me: “Oh yes, sir! I need to know how in case there is no one else around who can do the surgery.”
Experienced Doctor: “Wrong! You should only do Surgery and OB if you like doing them.”
His point was that if you do what you love and feel comfortable with, you will be a better International Doctor. In Ecuador, when the patient needed a Caesarian Section, we called in the surgeon. Since the surgeon was more experienced at cutting and sewing, he took the baby out and sewed the patient back up. He was the best person for the job, and the Family Practice doctors were better at receiving the baby and doing neonatal resuscitation when it was necessary. So the Family Doctor would decide when a C/section was necessary, but the Surgeon would do the work.
In Ecuador, we had surgeons and anesthesiologists. In Malawi, we don’t have surgeons, we don’t have anesthesiologists and we don’t have an operating room. There are other hospitals with all of those within an hour’s drive, both missionary and government hospitals. They have the personnel and equipment to do surgeries properly.
A doctor who is unpracticed in what he’s doing combined with lack of facilities and staff members who don’t know what they are doing is a real recipe for hurting someone. Having a plan in place for what to do if a surgical patient walks in the door is much better than trying a surgery you have not done in years. Of course, in dire emergency, with no other options, trying a surgery may the best option, but exploring all the other options first is vital.
Another issue is that a surgeon is only as good as the anesthesiologist working with him or her. There’s a reason that anesthesiology is a four year residency, there’s a lot to learn. Putting someone to sleep and waking them up again looks easy because anesthesiologists are really good at what they do and they have trained a long time. Anesthesia and surgery are not places for amateurs.
So unless the doctor is cut off from any other resources for many days, knowing where the best available surgeons and anesthesiologists are is far better for the patient than attempting a procedure you have never done. Patients often can be stabilized and moved to a proper facility in about the same time that it takes to find all of the instruments when the doctor and the staff rarely use them.
Tuesday, May 10, 2011
What I Thought I Needed to Know to be an International Doctor, and What I Really Needed to Know
Section 1
What can we learn from one doctor’s experience? The most important thing to learn is that one experience is not everyone’s experience. I have had a pediatrician colleague who had to do a Caesarian Section because he was the most qualified person available at his hospital in Gabon, Africa and it needed to be done. I have also heard of overseas physicians who put the patient to sleep themselves, then operated while every few minutes stepping to the other side of the curtain to ask the patient how she was doing. Thankfully, I have never had to reach that far to care for a patient.
Many doctors have a variety of experiences. Few have to be the Lone Ranger who can do everything by themselves, but most have to adjust to the medical environment and medical personnel as they are. When I was a medical student, I thought I needed to know how to do a lot of things all by myself. What I really needed to know was how to learn while making decisions, how to adjust to changing situations and medicine stocks, how to work with professionals of various cultures and education levels, all while having the final responsibility as “captain of the ship”.
I have been a missionary doctor for seven years, five in Shell, Ecuador on the edge of the Amazon rainforest, and two in Lilongwe, Malawi, a tiny country in southeastern Africa. While I was a resident, I spent two months in a mission hospital in Washim, India. Each experience taught me more about what a missionary doctor really does and who a missionary doctor really is.
What can we learn from one doctor’s experience? The most important thing to learn is that one experience is not everyone’s experience. I have had a pediatrician colleague who had to do a Caesarian Section because he was the most qualified person available at his hospital in Gabon, Africa and it needed to be done. I have also heard of overseas physicians who put the patient to sleep themselves, then operated while every few minutes stepping to the other side of the curtain to ask the patient how she was doing. Thankfully, I have never had to reach that far to care for a patient.
Many doctors have a variety of experiences. Few have to be the Lone Ranger who can do everything by themselves, but most have to adjust to the medical environment and medical personnel as they are. When I was a medical student, I thought I needed to know how to do a lot of things all by myself. What I really needed to know was how to learn while making decisions, how to adjust to changing situations and medicine stocks, how to work with professionals of various cultures and education levels, all while having the final responsibility as “captain of the ship”.
I have been a missionary doctor for seven years, five in Shell, Ecuador on the edge of the Amazon rainforest, and two in Lilongwe, Malawi, a tiny country in southeastern Africa. While I was a resident, I spent two months in a mission hospital in Washim, India. Each experience taught me more about what a missionary doctor really does and who a missionary doctor really is.
Saturday, January 22, 2011
It's Official, We're Staying Another Year
Since we returned to Malawi in September, we have been praying about how long we should stay. Logic has a number of reasons to stay through June 2012 and a number of reasons to leave in the summer of 2011. But the Lord says,
Human logic is nice, but God has a plan for our lives that at times defies human logic, but is always the best plan. So we prayed. We prayed for three months.
As we prayed, it became apparent that God wanted us to stay until June 2012. The logical reasons to stay are that Andrew will graduate high school From African Bible College Christian Academy and we will stay be here while our director spends a year on furlough. Those reasons are nice, but they pale in comparison to the most important reason, God directed us to stay.
We’re excited about staying. The time in Malawi hasn’t been easy, but it has been a time of tremendous growth for each of us individually and as a family. We are a happier, closer family for working through the hard issues that Malawi brought up. If nothing else good happens, we’re grateful to the Lord for bringing us together.
How did the Lord bring us together? Our time in Link Care helped us to talk about what each of us wanted from the family and work on setting goals as a family. That time also taught us that “You are who you are, not what you do.” Try reading the Gospels with that thought in the back of your mind. It seems like that is much of what Jesus is saying.
So, we are here following God’s will, asking for your prayers that we will follow His perfect will joyfully, and that He will give us direction for our next step in June 2012.
Isaiah 55:8-9
8 “For my thoughts are not your thoughts,
neither are your ways my ways,”
declares the LORD.
9 “As the heavens are higher than the earth,
so are my ways higher than your ways
and my thoughts than your thoughts.
Human logic is nice, but God has a plan for our lives that at times defies human logic, but is always the best plan. So we prayed. We prayed for three months.
As we prayed, it became apparent that God wanted us to stay until June 2012. The logical reasons to stay are that Andrew will graduate high school From African Bible College Christian Academy and we will stay be here while our director spends a year on furlough. Those reasons are nice, but they pale in comparison to the most important reason, God directed us to stay.
We’re excited about staying. The time in Malawi hasn’t been easy, but it has been a time of tremendous growth for each of us individually and as a family. We are a happier, closer family for working through the hard issues that Malawi brought up. If nothing else good happens, we’re grateful to the Lord for bringing us together.
How did the Lord bring us together? Our time in Link Care helped us to talk about what each of us wanted from the family and work on setting goals as a family. That time also taught us that “You are who you are, not what you do.” Try reading the Gospels with that thought in the back of your mind. It seems like that is much of what Jesus is saying.
So, we are here following God’s will, asking for your prayers that we will follow His perfect will joyfully, and that He will give us direction for our next step in June 2012.
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