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.
Saturday, October 2, 2010
15 year olds shouldn’t have AIDS
This week I thought I was seeing a 15 year old boy with a stomach ache, until I looked in his mouth and saw Candida (a fungus). Oops. He was there with his mother, so I had to tell them I suspected AIDS. I sent them to VCT, Voluntary Counseling and Testing, and he was positive. He probably has fungus growing all along his esophagus, which puts him at stage 4 out of 4 AIDS. That is pretty darn sick.
He had very cool shades and a very macho black T shirt, but he was choking back tears as I was telling him all about HIV. I’m not surprised. His world just turned upside down. Now instead of looking at another 60 years, he might be looking at another 10 years, 15 tops.
How did he get AIDS? There are three possibilities:
1. He was born with it. No one else in the family knows their status, so He could have been born with it, having gotten it in his mother's womb. It would be late to present, at age 15, but he is from a well-to-do family, so he could have been healthy enough all along.
2. He could have started having sex at age 12 or 13. That would be odd that he would get that sick that fast from 2 or 3 years of sexual activity, but it's possible.
3. He could have been molested. He has been at boarding school for two years, so he could have been molested by one of the older boys or by a teacher or another adult.
So, as we get to know each other a lot in the coming months, it may come out how he thinks he might have become infected. The how doesn’t matter much now. He is infected and sick. The why doesn’t matter much either. He is unlucky in a fallen world.
The only question s that matter now are “Who?” and “How?”
Who? : Not, “Who gave this to me?” But, “Who do I turn to since my life has flipped upside down?” I will humbly be suggesting that he turn to Jesus. He probably won’t make the infection go away nor will He punish the infector on this Earth, but He will be with the young man as he struggles to live a healthy life. Jesus will sustain him when there seems no hope. Jesus will redeem his soul. It doesn’t seem like much consolation from a 15 year old boy’s point of view, but it is all we have on this Earth.
How? : Not, “How do I get even?” or “How do I get rid of this?” but “How do I live with this horror?” I will also humbly suggest that Jesus is the same answer to that different question. Jesus can turn horror into hope. There isn’t anything redeeming about dying young or being sick young, but there is redemption in eventually using his illness to help others who are ill and to give glory to God.
How does AIDS in a boy who is just becoming a man glorify God? I don’t have a clue how it will happen, or even how it can happen, but I pray that glory does come out of this. I pray I can give some comfort as he starts this very sad journey.
He had very cool shades and a very macho black T shirt, but he was choking back tears as I was telling him all about HIV. I’m not surprised. His world just turned upside down. Now instead of looking at another 60 years, he might be looking at another 10 years, 15 tops.
How did he get AIDS? There are three possibilities:
1. He was born with it. No one else in the family knows their status, so He could have been born with it, having gotten it in his mother's womb. It would be late to present, at age 15, but he is from a well-to-do family, so he could have been healthy enough all along.
2. He could have started having sex at age 12 or 13. That would be odd that he would get that sick that fast from 2 or 3 years of sexual activity, but it's possible.
3. He could have been molested. He has been at boarding school for two years, so he could have been molested by one of the older boys or by a teacher or another adult.
So, as we get to know each other a lot in the coming months, it may come out how he thinks he might have become infected. The how doesn’t matter much now. He is infected and sick. The why doesn’t matter much either. He is unlucky in a fallen world.
The only question s that matter now are “Who?” and “How?”
Who? : Not, “Who gave this to me?” But, “Who do I turn to since my life has flipped upside down?” I will humbly be suggesting that he turn to Jesus. He probably won’t make the infection go away nor will He punish the infector on this Earth, but He will be with the young man as he struggles to live a healthy life. Jesus will sustain him when there seems no hope. Jesus will redeem his soul. It doesn’t seem like much consolation from a 15 year old boy’s point of view, but it is all we have on this Earth.
How? : Not, “How do I get even?” or “How do I get rid of this?” but “How do I live with this horror?” I will also humbly suggest that Jesus is the same answer to that different question. Jesus can turn horror into hope. There isn’t anything redeeming about dying young or being sick young, but there is redemption in eventually using his illness to help others who are ill and to give glory to God.
How does AIDS in a boy who is just becoming a man glorify God? I don’t have a clue how it will happen, or even how it can happen, but I pray that glory does come out of this. I pray I can give some comfort as he starts this very sad journey.
Friday, May 7, 2010
Zacharias is with the Lord
The young man with juvenile arthritis that Elizabeth was caring for passed away about one month ago. We learned of his passing last week.
As you can see from his picture, Zacharias was very unhealthy. He was often fed only every two to three days by his family. When Elizabeth would see him, he would be lying in his own excrement and urine, covered in flies and bed sores, and often hadn’t eaten in a day or two.
Thanks to Elizabeth and Jessica McMillan, Zaccarias was moved from his village to the Michinje District Hospital. When they visited him there, Zacharias said he preferred staying in the hospital because they fed him and bathed him.
On one of her visits to Zacharias’ village, Elizabeth took a woman who spoke Chichewa to explain to Zacharias about Jesus love and His forgiveness of sins. Zacharias accepted Jesus as his Savior that day.
It is horribly sad that an eighteen year old boy who just had arthritis died, but because of Elizabeth and Jessica, he died clean and fed and most importantly, saved. Thank you Elizabeth, thank you Jessica and thank you God.
As you can see from his picture, Zacharias was very unhealthy. He was often fed only every two to three days by his family. When Elizabeth would see him, he would be lying in his own excrement and urine, covered in flies and bed sores, and often hadn’t eaten in a day or two.
Thanks to Elizabeth and Jessica McMillan, Zaccarias was moved from his village to the Michinje District Hospital. When they visited him there, Zacharias said he preferred staying in the hospital because they fed him and bathed him.
On one of her visits to Zacharias’ village, Elizabeth took a woman who spoke Chichewa to explain to Zacharias about Jesus love and His forgiveness of sins. Zacharias accepted Jesus as his Savior that day.
It is horribly sad that an eighteen year old boy who just had arthritis died, but because of Elizabeth and Jessica, he died clean and fed and most importantly, saved. Thank you Elizabeth, thank you Jessica and thank you God.
Saturday, March 20, 2010
Chicha: Yum, Yum
One of the more interesting items that comes form the jungle of Ecuador is chicha.
In the jungle, there is food, but keeping it fresh without refrigerators, canning and other modern conveniences is hard. Rodents are everywhere, as are bugs, rot, fungus, and all other kind of things that ruin food.
So, what is chicha? Yucca root, also known as manioc or cassava, is chewed up by the women, spit into a bucket and allowed to ferment. In the jungle, each woman makes her own chicha from her own batch of spit. Then to show their hospitality, each woman wants you to try her own special brand of fermented spit.
You may be asking, “What does chicha taste like?” Elizabeth says it tastes like warm, lumpy beer. Jerry says it tastes like a mixture of skim milk and vinegar. Both descriptions way oversell the quality of the brew.
So why do people make chicha, and more importantly, why in Heaven’s name would anyone consume it? Both are very good questions.
Adults consume chicha for two reasons. Since as long as history has been written, almost every culture and civilization has writings of epic heroes and recipes for beer. People just like to get drunk. I used to like to get drunk, and can’t for the life of me remember why I thought I was having fun. Go to most college campuses on a Thursday, Friday or Saturday and you will find a large number of young people spending their parents money. By studying? No, by drinking fermented beverages and thinking they are having a great time. Most cultures consume alcohol, and the jungles of Ecuador host a number of tribal cultures that like drinking.
The second reason is that from the time jungle children are young, they drink chicha. The water is mud brown and the open sewer from the Andes at 16,000 feet down to the 1000 feet of the jungle. That’s 15,000 feet and miles of human sewage. It’s hard to imagine that fermented spit is more sanitary than anything, especially river water, but in the Amazon chicha is definitely a cleaner beverage. Even a couple of days of fermenting will keep the starch from going bad. Being a liquid, rodents don’t go for the chicha, and mold is less likely to grow so in a really low tech way, chicha is a way to store starch.
Chicha is a comfort food for people from the jungle. It’s what fills your belly when you are a kid. It’s what you drank to get your first buzz as a teenager. It is what you drink after a tough day in the jungle or after a long hunt.
True chicha stories:
> Folks from the jungle will bring chicha on the missionary airplanes when they fly, since you can’t buy chicha in the stores in town. Since it is a fermented drink, it doesn’t like the drop in pressure as the plane goes up to 10,000 feet. Sometime when it is brought out of the storage locker under the plane, the chicha will burst out of the two liter coke bottle it flies in and soak the pilot or ground crew with fermented starch spit.
> I watched a jungle nurse, a man, suck down almost two bowls of chicha after work one day. I saw him again about 45 minutes later, quite tipsy. The alcohol is real.
> Chicha is drunk from a bowl, not a frosted mug. The bowl is made out of a hollowed gourd or a turtle shell.
That’s chicha. I don’t like it, but thousands of people who live in in the amazon rain forest have a right to what they like. Some people like to eat raw fish on a wad of rice, but sushi is a different blog.
In the jungle, there is food, but keeping it fresh without refrigerators, canning and other modern conveniences is hard. Rodents are everywhere, as are bugs, rot, fungus, and all other kind of things that ruin food.
So, what is chicha? Yucca root, also known as manioc or cassava, is chewed up by the women, spit into a bucket and allowed to ferment. In the jungle, each woman makes her own chicha from her own batch of spit. Then to show their hospitality, each woman wants you to try her own special brand of fermented spit.
You may be asking, “What does chicha taste like?” Elizabeth says it tastes like warm, lumpy beer. Jerry says it tastes like a mixture of skim milk and vinegar. Both descriptions way oversell the quality of the brew.
So why do people make chicha, and more importantly, why in Heaven’s name would anyone consume it? Both are very good questions.
Adults consume chicha for two reasons. Since as long as history has been written, almost every culture and civilization has writings of epic heroes and recipes for beer. People just like to get drunk. I used to like to get drunk, and can’t for the life of me remember why I thought I was having fun. Go to most college campuses on a Thursday, Friday or Saturday and you will find a large number of young people spending their parents money. By studying? No, by drinking fermented beverages and thinking they are having a great time. Most cultures consume alcohol, and the jungles of Ecuador host a number of tribal cultures that like drinking.
The second reason is that from the time jungle children are young, they drink chicha. The water is mud brown and the open sewer from the Andes at 16,000 feet down to the 1000 feet of the jungle. That’s 15,000 feet and miles of human sewage. It’s hard to imagine that fermented spit is more sanitary than anything, especially river water, but in the Amazon chicha is definitely a cleaner beverage. Even a couple of days of fermenting will keep the starch from going bad. Being a liquid, rodents don’t go for the chicha, and mold is less likely to grow so in a really low tech way, chicha is a way to store starch.
Chicha is a comfort food for people from the jungle. It’s what fills your belly when you are a kid. It’s what you drank to get your first buzz as a teenager. It is what you drink after a tough day in the jungle or after a long hunt.
True chicha stories:
> Folks from the jungle will bring chicha on the missionary airplanes when they fly, since you can’t buy chicha in the stores in town. Since it is a fermented drink, it doesn’t like the drop in pressure as the plane goes up to 10,000 feet. Sometime when it is brought out of the storage locker under the plane, the chicha will burst out of the two liter coke bottle it flies in and soak the pilot or ground crew with fermented starch spit.
> I watched a jungle nurse, a man, suck down almost two bowls of chicha after work one day. I saw him again about 45 minutes later, quite tipsy. The alcohol is real.
> Chicha is drunk from a bowl, not a frosted mug. The bowl is made out of a hollowed gourd or a turtle shell.
That’s chicha. I don’t like it, but thousands of people who live in in the amazon rain forest have a right to what they like. Some people like to eat raw fish on a wad of rice, but sushi is a different blog.
Sunday, March 7, 2010
New Partners in Hope Videos
Here is a new video about the new in patient ward at Partners in Hope. (Click on the title to see it. Pretty cool, eh?)
Blessings,
Jerry & Elizabeth
Blessings,
Jerry & Elizabeth
Sunday, February 28, 2010
Questions the Chinese guys have asked at our Bible Study. How would you answer?
1. Why didn’t God send a prophet to China?
2. When Jesus was staying in Jerusalem, did he stay in a hotel? (from the story of Jesus meeting Andrew and John in John 1)
3. In John 1:38 when Jesus showed John & Andrew where He was staying, did He take them to Heaven or where He was staying? Was it a hotel?
4. Jesus genetic make-up? (Was it 23 chromosomes from Mary & 23 from the Holy Spirit or all 46 from the Spirit or some other way? “You’re a doctor. You should know.”)
5. Was Jesus light or God or a man or words? (Prologue from John 1)
6. Is Muhammad a prophet?
7. Was John the Baptist a son of God?
8. Are trees, plants and animals sons of God?
Please us know how you would answer by clicking on Post a Comment.
2. When Jesus was staying in Jerusalem, did he stay in a hotel? (from the story of Jesus meeting Andrew and John in John 1)
3. In John 1:38 when Jesus showed John & Andrew where He was staying, did He take them to Heaven or where He was staying? Was it a hotel?
4. Jesus genetic make-up? (Was it 23 chromosomes from Mary & 23 from the Holy Spirit or all 46 from the Spirit or some other way? “You’re a doctor. You should know.”)
5. Was Jesus light or God or a man or words? (Prologue from John 1)
6. Is Muhammad a prophet?
7. Was John the Baptist a son of God?
8. Are trees, plants and animals sons of God?
Please us know how you would answer by clicking on Post a Comment.
Monday, February 15, 2010
It Just So Happened
Sometimes something just falls into your lap, and you know God dropped it there.
Jerry was working at the main public hospital here, and happened to meet a young Chinese man volunteering at the same hospital with a Chinese government program. It happened that this young man is a Christian. It also happened that he lives just down the street from us.
So Jerry went over one day and took some avocados from our tree to Tuki. They prayed together, Jerry in English, and Tuki in Chinese. Jerry invited Tuki to a Bible study starting in our area that happened to be next door to Tuki’s house, run by an English businessman who goes to our church. When Tuki came he brought three other Chinese volunteers with him and the following week he brought five. Through very broken English we found out that these young people had never met any Christians until they came to Africa and that they were eager to learn about God and about what Christianity is all about.
In Ecuador, Elizabeth used a Bible Study in Spanish that was especially designed for people who have never looked at a Bible, and concluded that it would be useful now if we had it in English. She determined to translate it herself. Well, guess what? It happened to have been translated in to English last year.
After printing out scanned copies of the Bible Study sent from Ecuador, we walked over to Tuki’s house and gave homework to a bunch of enthusiastic young people. We started with the Gospel of John. Friday was the first day of the new Chinese Bible study for Chinese volunteers curious about Christianity.
The students came ready with homework done, and loaded with questions like, “Why did God send prophets to Israel, not to China?”
“Was Jesus just light or spirit or man?”
“Are animals and plants children of God?”
“Was John the Baptist the son of God, too?”
After an hour of lively discussion we had only covered the first nine verses of Chapter One but there were smiles all around and enthusiasm to continue on next week. And off they quickly went to prepare dumplings, because tomorrow happened to be Chinese New Year and we happened to receive a last minute invitation.
Jerry was working at the main public hospital here, and happened to meet a young Chinese man volunteering at the same hospital with a Chinese government program. It happened that this young man is a Christian. It also happened that he lives just down the street from us.
So Jerry went over one day and took some avocados from our tree to Tuki. They prayed together, Jerry in English, and Tuki in Chinese. Jerry invited Tuki to a Bible study starting in our area that happened to be next door to Tuki’s house, run by an English businessman who goes to our church. When Tuki came he brought three other Chinese volunteers with him and the following week he brought five. Through very broken English we found out that these young people had never met any Christians until they came to Africa and that they were eager to learn about God and about what Christianity is all about.
In Ecuador, Elizabeth used a Bible Study in Spanish that was especially designed for people who have never looked at a Bible, and concluded that it would be useful now if we had it in English. She determined to translate it herself. Well, guess what? It happened to have been translated in to English last year.
After printing out scanned copies of the Bible Study sent from Ecuador, we walked over to Tuki’s house and gave homework to a bunch of enthusiastic young people. We started with the Gospel of John. Friday was the first day of the new Chinese Bible study for Chinese volunteers curious about Christianity.
The students came ready with homework done, and loaded with questions like, “Why did God send prophets to Israel, not to China?”
“Was Jesus just light or spirit or man?”
“Are animals and plants children of God?”
“Was John the Baptist the son of God, too?”
After an hour of lively discussion we had only covered the first nine verses of Chapter One but there were smiles all around and enthusiasm to continue on next week. And off they quickly went to prepare dumplings, because tomorrow happened to be Chinese New Year and we happened to receive a last minute invitation.
Friday, February 12, 2010
The Adventures of Molly the Catatonic Kitty
We adopted Jessica’s cat on Tuesday. The poor cat was catatonic all day long. She hid between Lorraine’s mattress and the wall all day long. When Lorraine would pull her out of the space, Molly would go right back to the gap. After a number of hours, Molly finally would go about six inches from the wall and let Lorraine pet her, but only as long a Lorraine kept holding her.
This went on for a whole day and night. The next day Molly actually walked around the girls’ room. She wouldn’t venture out of the room, but she would actually sit on the desk, looking out the window and meow to get out. That was an improvement until the early hours of day two with the catatonic kitty, when she started meowing loudly and insistently that she wanted to go hunting at 5 am. In a battle of wills between a cat and a human, even two humans, the cat will win. Molly won. The girls came to our room to sleep, and Elizabeth went to try to sleep in their room for two good reasons: 1) she is a self sacrificial mother who will do almost anything for her “babies” even when her babies are almost her height, and 2) she was so sick that night that she hardly slept anyway, with or without the cat.
On day three the cat gave us a fright that she had run off. Andrew left the back door open and Molly couldn’t be found for a few tense seconds. She had gone to the porch but came back at Elizabeth’s call. Why are we keeping the cat locked up inside? We were told by cat people it takes a week for a cat to imprint on a new home, so we are keeping her locked in the house for a week to let her imprint on our house, then she can go back to her catly duties like hunting rodents and snakes and placing the rotting corpses under our bed. We can’t wait.
We are up to day four now, and Patty the mop dog is about to learn about his new competition for our cuddling affections. Right now he is just confused as to why we aren’t letting him track the red mud of Malawi into our house. In a mere three days we can open the doors again to let Molly out and Patty in. We can’t wait.
This went on for a whole day and night. The next day Molly actually walked around the girls’ room. She wouldn’t venture out of the room, but she would actually sit on the desk, looking out the window and meow to get out. That was an improvement until the early hours of day two with the catatonic kitty, when she started meowing loudly and insistently that she wanted to go hunting at 5 am. In a battle of wills between a cat and a human, even two humans, the cat will win. Molly won. The girls came to our room to sleep, and Elizabeth went to try to sleep in their room for two good reasons: 1) she is a self sacrificial mother who will do almost anything for her “babies” even when her babies are almost her height, and 2) she was so sick that night that she hardly slept anyway, with or without the cat.
On day three the cat gave us a fright that she had run off. Andrew left the back door open and Molly couldn’t be found for a few tense seconds. She had gone to the porch but came back at Elizabeth’s call. Why are we keeping the cat locked up inside? We were told by cat people it takes a week for a cat to imprint on a new home, so we are keeping her locked in the house for a week to let her imprint on our house, then she can go back to her catly duties like hunting rodents and snakes and placing the rotting corpses under our bed. We can’t wait.
We are up to day four now, and Patty the mop dog is about to learn about his new competition for our cuddling affections. Right now he is just confused as to why we aren’t letting him track the red mud of Malawi into our house. In a mere three days we can open the doors again to let Molly out and Patty in. We can’t wait.
Thursday, February 4, 2010
Both Hands Tied Behind Our Backs
Professionally, I’m having a blast. I’m at the government hospital in the capital, Lilongwe, which makes Wishard look like Clarian North.
We had two kids die of rabies last week. One of the kids was bitten on Christmas Day. It was a 1/4 inch lesion on the thumb. The parents took the kid to the health center, but it was closed on Christmas day. Since Christmas was on a Friday, by Monday they thought, “It looks OK,” so didn’t take him back. He didn’t start the post bite vaccines at all and died a month later. He had hyperreflexia followed by hyporeflexia, progressive paralysis, and myoedema. The other kid, 12 y/o, had the foaming at the mouth. I’ve now seen four cases of rabies in six years: 2 in Malawi, 2 in Ecuador.
You can ask, “Why didn’t we use the Milwaukee protocol (induce a coma for 3 weeks)?” We didn’t even think about it because there are only three ventilators in the hospital, and only one can handle kids. It’s not right to use such a limited resource for a kid who has a 0.01% chance of living, even after a month long induced coma. There are also only 3 working dialysis machines in the country, all at the hospital where I'm working.
I’ve been a doc for 17 years and only encountered Burkitt’s lymphoma on board exams. In one hour I saw 15 kids with Burkitt’s lymphoma. A General Practice doctor from Nigeria has an interest in Burkitt’s & pediatric cancers, so he does the Burkitt’s kids. (Burkitt's lymphoma has mortality anywhere from 5-30%, depending on the stage when diagnosed and whether they relapse after chemotherapy.)
I took a sample of peritoneal fluid to the lab on January 3rd. Since I couldn’t find a lab tech anywhere in the lab, I put the sample down on the counter, right next to a sample of peritoneal from the SAME patient dated December 31st. It had been sitting on the counter for 4 days, untouched by human hands. All the crud growing in the test tube wasn’t so much of an issue because we can’t do cultures here. You are lucky to get a cell count, glucose and protein. My issue was that I had done all I could for the patient and if no one could do even five minutes of work over four days to help another human being, and the systems were so nonexistent that labs samples can go untouched for four days, there wasn’t anything else I could do. So, I just got in my car and drove home.
I did come back the next day. (That’s the difference between being fed up and giving up.)
Mind you, this is the free labor I’m doing in the government hospital to get my medical license. Tomorrow is my last day. Not that I’m counting, (20 hours).
Next week I start at Partners in Hope. It’s not a perfect place, and it has similar problems with motivated staff, but we can fire people who don’t do their work, pray with our patients and at least know that most everyone at the hospital cares about the patient.
This is getting long and might look depressing, but since most of the patients get better and go home, and we actually can make a huge difference. “We had both hands tied behind our back and STILL saved the patient.”
Three factoids before I quit.
1. There are three residency trained pediatricians in a country of 14 million, two here in Lilongwe and one at Queen Elizabeth Hospital in Blantyre.
2. Every day at morning report on the pediatrics ward they discuss the admissions and the deaths. There are 3 – 9 deaths per day. That’s one death every 3 to 8 hours. (In the US, if a child dies in the hospital, the whole building goes into mourning.)
3. No one can get reliable data about admissions and deaths, but the estimate is that the mortality rate is 9.1% of all pediatric admissions, down from 9.6% last year.
We had two kids die of rabies last week. One of the kids was bitten on Christmas Day. It was a 1/4 inch lesion on the thumb. The parents took the kid to the health center, but it was closed on Christmas day. Since Christmas was on a Friday, by Monday they thought, “It looks OK,” so didn’t take him back. He didn’t start the post bite vaccines at all and died a month later. He had hyperreflexia followed by hyporeflexia, progressive paralysis, and myoedema. The other kid, 12 y/o, had the foaming at the mouth. I’ve now seen four cases of rabies in six years: 2 in Malawi, 2 in Ecuador.
You can ask, “Why didn’t we use the Milwaukee protocol (induce a coma for 3 weeks)?” We didn’t even think about it because there are only three ventilators in the hospital, and only one can handle kids. It’s not right to use such a limited resource for a kid who has a 0.01% chance of living, even after a month long induced coma. There are also only 3 working dialysis machines in the country, all at the hospital where I'm working.
I’ve been a doc for 17 years and only encountered Burkitt’s lymphoma on board exams. In one hour I saw 15 kids with Burkitt’s lymphoma. A General Practice doctor from Nigeria has an interest in Burkitt’s & pediatric cancers, so he does the Burkitt’s kids. (Burkitt's lymphoma has mortality anywhere from 5-30%, depending on the stage when diagnosed and whether they relapse after chemotherapy.)
I took a sample of peritoneal fluid to the lab on January 3rd. Since I couldn’t find a lab tech anywhere in the lab, I put the sample down on the counter, right next to a sample of peritoneal from the SAME patient dated December 31st. It had been sitting on the counter for 4 days, untouched by human hands. All the crud growing in the test tube wasn’t so much of an issue because we can’t do cultures here. You are lucky to get a cell count, glucose and protein. My issue was that I had done all I could for the patient and if no one could do even five minutes of work over four days to help another human being, and the systems were so nonexistent that labs samples can go untouched for four days, there wasn’t anything else I could do. So, I just got in my car and drove home.
I did come back the next day. (That’s the difference between being fed up and giving up.)
Mind you, this is the free labor I’m doing in the government hospital to get my medical license. Tomorrow is my last day. Not that I’m counting, (20 hours).
Next week I start at Partners in Hope. It’s not a perfect place, and it has similar problems with motivated staff, but we can fire people who don’t do their work, pray with our patients and at least know that most everyone at the hospital cares about the patient.
This is getting long and might look depressing, but since most of the patients get better and go home, and we actually can make a huge difference. “We had both hands tied behind our back and STILL saved the patient.”
Three factoids before I quit.
1. There are three residency trained pediatricians in a country of 14 million, two here in Lilongwe and one at Queen Elizabeth Hospital in Blantyre.
2. Every day at morning report on the pediatrics ward they discuss the admissions and the deaths. There are 3 – 9 deaths per day. That’s one death every 3 to 8 hours. (In the US, if a child dies in the hospital, the whole building goes into mourning.)
3. No one can get reliable data about admissions and deaths, but the estimate is that the mortality rate is 9.1% of all pediatric admissions, down from 9.6% last year.
Sunday, January 24, 2010
HCJB In Haiti
HCJB sent a team to Haiti.
See the photos on the BBC website.
http://news.bbc.co.uk/2/hi/americas/8466989.stm
See the photos on the BBC website.
http://news.bbc.co.uk/2/hi/americas/8466989.stm
Tuesday, January 12, 2010
The Patient Died Before I Got to See Him
Yesterday was Monday. The doctors divided up the patients who came in over the weekend. I had six. I started seeing them one by one, and as I came into a room, there was a body wrapped up and ready for the morgue.
I asked, with some anxiety, “Is that Charles?”
“Yes.”
“Do you need help putting the body on the gurney?”
“Yes, but you don’t have gloves on, so don’t help.”
It was sad that my patient died even before I got to see him. At least I don’t feel guilty that he died while under my care or even under my stethoscope. It is a recurrent problem here that patients came long after it is too late. They are not comfortable with western medicine, a place that is totally unfamiliar: multi-story buildings, electricity, odd looking machines, even elevators.
You can see little nicks with black tint on the sick part of the body made by the medicine man. The patients are so much more comfortable with the witch doctor. He lives in their village. He speaks their language. He lives in a grass hut like they do. He believes in curses, demons and ancestor worship like many Malawians do. He may even place curses or say that he can prevent curses. By the time the family has given up on the medicine man they are long past the point where we could have helped.
I don’t know what the story was with Charles. I never even got to see him.
Blessings - Jerry
I asked, with some anxiety, “Is that Charles?”
“Yes.”
“Do you need help putting the body on the gurney?”
“Yes, but you don’t have gloves on, so don’t help.”
It was sad that my patient died even before I got to see him. At least I don’t feel guilty that he died while under my care or even under my stethoscope. It is a recurrent problem here that patients came long after it is too late. They are not comfortable with western medicine, a place that is totally unfamiliar: multi-story buildings, electricity, odd looking machines, even elevators.
You can see little nicks with black tint on the sick part of the body made by the medicine man. The patients are so much more comfortable with the witch doctor. He lives in their village. He speaks their language. He lives in a grass hut like they do. He believes in curses, demons and ancestor worship like many Malawians do. He may even place curses or say that he can prevent curses. By the time the family has given up on the medicine man they are long past the point where we could have helped.
I don’t know what the story was with Charles. I never even got to see him.
Blessings - Jerry
Sunday, January 3, 2010
Happy New Year everyone, Happy New Decade!
This year started in a cold Midwest winter and ended in the warm heart of Africa. We have just moved into a “permanent” house here and it’s already feeling a bit like home. Home for me is not really a place. I’ve lived in eight countries and five states. The longest I’ve lived any where is eight years (five of them while I was in college). Home for me is a feeling, a feeling of comfort and security. I feel it most with family and with friends that have lasted over several moves. I feel it in prayer sometimes. I begin feeling it after about six months in a new place. Still, sometimes no matter how long I’ve been somewhere, there is a longing for “home”, whatever and wherever that is. We Christians are fond of saying that our home is in Heaven, so maybe that’s as things should be.
We wish everyone a sense of home in this New Year, and praying that Malawi would indeed become home for us this year.
Saturday, October 31, 2009
Under 5's Clinic
Teaching health care practices with song and dance in Malawi! I filmed this with my camera at an under 5's clinic I helped out in about one and a half hours outside of Lilongwe.
Saturday, October 17, 2009
Update on Zachariah
We were able to go back to the village where Zachariah lives. With the help from the Malawian government we could bring him some food supplements, it’s a food called “plumpy nut” which is like peanut butter, and has the protein and nutritional supplements he will need. We also were able to secure a wheelchair that was donated by the Rotary Club. The best news of all however, is that a chief from a neighboring village has agreed to be responsible to make sure he is fed and taken outside daily. On the bad news side, we found he has developed a bed sore, and for someone in his condition it could prove fatal. I washed and dressed the wound with the few first aid supplies I had, and we left with words of encouragement. I’m not sure how much future he’s going to have, but maybe he can have a few nice days in the sun.
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