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.

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.

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.

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

Is This the Quiet Week We’ve All Been Hoping For?

We have four patients in the hospital. Yesterday we had seven, but two went home and one was transferred to Hospital Vozandes Quito because he had a heart attack that wouldn’t slow down.

Why are things slow here in Shell? There’s a strike. Strikes in Ecuador don’t just have people with signs walking in a circle, that doesn’t get the attention of the authorities. A strike in Ecuador is not a strike without roadblocks and burning tires. The strikers have found out that the police can pull apart a roadblock of burning tires lined up across the road with long metal poles, so now they use dump truck loads of dirt on the road so no one can pass until they decide to end the strike. Burning tires make great TV shots and blocking the roads brings capitalism to the aid of the strikers. The truckers and bus companies want to travel and make money, so they pressure the authorities to give in to the strikers' demands.

The semi-good thing about a strike for a day or two is that hardly anyone can come to the clinic, which means we don’t operate, which doesn’t affect me, but we also have very few patients in the clinic, which gives me time to catch up on my journal, emails and other important communication.

The bad thing about strikes is that travel gets bogged down. Our ophthalmologist, eye doctor, got stuck about 10 miles away. They let ambulances through, so our ambulance went to get him from the far side of the barricade. He called us to ask the ambulance driver to come get him. Thank goodness for cell phones.

Another bad thing is that the medical student who took the patient having the heart attack to Quito got stuck about 2 am ten miles away from the hospital. She tried to sleep on the gurney in the back of the ambulance, but when the ambulance driver lay down on a bench and started to snore loudly, she didn’t sleep anymore that night. She ended up walking with some patients in the rain, coming from 4 hours away to our fair hospital about 5 am. She is about 22. They are about 70, but because they walk everywhere out in the rural areas, and they have worked at manual labor all their lives, they walked her into the ground and the old folks had to slow down so that the young college student could keep up.

The worst thing is that the patients who need to come to the doctor can’t get here. The ophthalmologist is only here one week per month. Most of the patients who received operations last month can’t get in for their follow ups appointments, and patients who need to come to the clinic can’t get around the barricades. For me, the worst thing is there’s no bread and no Diet Coke in the stores. We missionaries really suffer. (Just kidding.)

Tomorrow, if the strike ends, we will be extra busy. If the strike drags on, patients who early need care won’t get it, and that could be tragic. For now, it’s just a relaxing slow day after a few weeks of horror.

Something about me

Elizabeth tells her story

I grew up in a nominally Catholic home. I also grew up as an expatriate in South America, my father was a businessman, and in my youth I met a number of children of missionaries. I first heard the gospel in an understandable way from missionaries when I was fifteen years old. When I went to college in the US, God brought me to a church where I could learn and grow in my faith.

In college I decided to study nursing specifically so I could do mission work anywhere in the world. A few years out of college I joined a church planting team to start a Hispanic church in Miami, Florida. I began graduate school to become a Nurse Midwife, when I met Jerry at the University of Miami. We married and moved to Tampa for him to start medical school. During the following years I entered a time of serious questioning and exploration of my faith, and at the same time we began having our children. I thank God for this time, as it helped sharpen and mature me, and prepare me for service.

We moved to Tucson AZ in 1996, so Jerry could work at a community health center and help pay back the student loans he owed. We became involved in leading a marriage ministry (and worked on our own marriage as well!). By 2002 all our student debt was paid. We applied to HCJB World Radio after exploring other medical mission’s options at the Yearly Global Medical Missions conference in Kentucky. I remember seeing the tremendous medical need in Africa, yet feeling that we fit better with South America. As I was struggling with that idea, I spoke with a representative of HCJB World Radio Inc. who told me of a great place to work for in Ecuador, but that they were opening doors to Africa, and looking at options in Malawi! I thought, “What a perfect fit, we could get our missionary feet wet in ‘comfortable’ South America, and yet Africa could be in our future some day!”

We have been in Ecuador for four wonderful years. I’ve worked part time in the hospital, begun a health education and community outreach program and started and a pre and post test counseling program for our HIV. I also lead an evangelical Bible study for Ecuadorian women who have had little or no background in the Bible. We have loved living and serving our awesome God here, and don’t feel our time for serving in missions is anywhere near up. Perhaps, If God allows we can continue to serve Him with the needs He puts before us in Malawi.

“My Father is glorified by this, that you bear much fruit…” John 15:8

Elizabeth Koleski

Mud Slide Slim

Since children in the jungle don't get to go sledding on snow, they still can slide down hills. Here, they go mud sliding.

The day started with the kids trying to slide on a large sheet of plastic wet down with spay water. They quickly discovered that the plastic wanted to slide down the hill with them. Since the first try was not fun enough, fast enough or dirty enough for the kids, the kids decided just to slide on the mud. It made a huge mess, grinding mud into their clothes. After they were done, they turned the bathroom into a new mud pit.

The great thing about kids is that they will make their own fun, and are usually more creative than the adults around them.

Blessings,
Jerry and Elizabeth