Much of the shea butter of the world is produced in the region around Tamale, Ghana, where we’ll be moving. I loved this touching video showing how Fair Trade purchasing of shea butter by The Body Shop gives women not only jobs, but it also builds clinics, schools, and wells for the rural communities around Tamale. (And it makes a great Christmas gift!)

I also am falling in love with the faces and voices of the women in northern Ghana. I remember meeting a woman in college who was from Ghana, and falling in love with her accent. I could sit and listen to her for hours, and always wanted to work with her in groups, just so I could hear her speak. I can’t wait to be around Ghanaian English every day!

Last year at this time, I was gathered around with a group of friends at a Christmas party. The fireplace was crackling, coffee was brewing, desserts were digesting, and we were reflecting on how God was speaking to us at Christmas.

For me, it was the Incarnation. Why in the world would an omnipotent God wrap Himself in flesh to be born as a baby in a stable? Imagining the situation anew is almost offensive. Jesus, please, not in a manger, there’s donkey drool in there. Please, Jesus, at least a small palace or the temple, not in a temporary shelter away from the comforts of home– anyone’s home. No Jesus, not born to a poor teenage girl from Nazareth — at least choose a family with some clout or prominence.  Your message is too important, Jesus, to not bring it to a better platform than a poor homeless baby wrapped in strips of cloth and lying in a feeding trough.

Today, I’ve still more comfortable with a Jesus who is not quite so humble. The Divine nature, I’m satisfied with. Healing disease, casting out demons, walking on water, ascending into Heaven on fluffy white clouds with crowds standing in awe — that’s a Jesus who is easy to get on board with.  It’s the mucking around with fishermen and tax collectors, hiding out as a refugee in a foreign land, starving in the wilderness that doesn’t sit well with me. The Creator of the nighttime stars depending on the kindness of strangers for a place to lay His head at dusk. Letting snotty little kids climb on His divine lap while He tousles and parts their matted hair with the same hands that parted the Red Sea.

It’s just, well, distasteful, Jesus.

While I am comfortable with the divinity of Christ, the indignity of the Incarnation is difficult. Why? Because if the Creator of the Universe is as Humble as He is Divine, there is no room for my own pride. My arrogance stands in stark contrast with a glorious Savior who chose humility when He deserved everything but.

If I am striving to be like Christ, I cannot only be comfortable with the trappings of His blessings, I need to embrace the trappings of His humility as well. I want Jesus to use me to heal and to teach because I love the splendor of His omnipotence. But if there a place I will not live, an indignity I will not endure, an economic status I will not tolerate, or a death I will not die for the sake of His kingdom, my pretense flies in the face of the humility of the Incarnation. After all, Jesus,

“Who, being in very nature God,
    did not consider equality with God something to be used to his own advantage;
rather, he made himself nothing
    by taking the very nature of a servant,
    being made in human likeness.
And being found in appearance as a man,
    he humbled himself
    by becoming obedient to death—
        even death on a cross!”

Philippians 2:6-8, NIV

Jesus, it would be so much easier if you were born to a wealthy public figure in a sterile maternity ward, lived in a 2500 square foot house with a couple of cars, and never spent a hungry or homeless night!

Two weeks ago, I explained the Incarnation to Addie and Palmer over dinner — how Jesus left the perfection of heaven to come and live on stinky earth. And even though Jesus deserved so much more, sometimes Jesus was hungry. And sometimes Jesus didn’t have a place to sleep at night.

The kids were wide-eyed in awe. “But sometimes in Africa we were really hungry and we didn’t have any food or know where we were going to sleep. Jesus knows what that’s like?”

There was no place He would not live, an indignity He would not endure, an economic status He would not tolerate, or a death He would not die for the sake of His kingdom.

Indeed, I’m blessed to embrace the Divine wrapped in the indignity of the Incarnation.

Academics has been my love for a long time. I started teaching at the university level 13 years ago, and I knew that it was a great fit for me. I love college student, I love teaching, and my profession is medicine. I’ve always called myself “half pastor, half professor.” It’s not that I don’t like practice — I do. But my issue with practice has always been the unnatural pace.

As annoying as it is for patients to have to wait to see a medical provider, it’s so much worse being a provider. In a typical appointment, I have to:

• Review the patient’s chart, all their past diseases and treatments, allergies, family history, etc.
• Interview the patient, letting them talk for at least 2 minutes, uninterrupted
• Negotiate a plan for the visit, based on their needs, and what I need to cover
• Finish interview
• Do physical exam
• Put all the symptoms together with the exam and make a diagnosis
• Determine patient’s need for treatment or testing
• Determine what needs to be done for health maintenance (routine bloodwork, testing, etc.)
• Order testing and write prescriptions, calculating dosages and checking for drug interactions
• Educate the patient on what they have, what needs to be done, and any side effects, expectations, etc.
• Document all of the above
• Code the visit for payment, assigning numbers which quantify the visit

Sometimes I’ve gotten 12 minutes a patient. Sometimes I’ve gotten 20. It’s really hard to do a good job while being efficient, personable, thorough, yet unhurried. It’s nearly impossible to truly look a patient in the eye and be present. And if one patient is running late, it sets the whole schedule back. It’s really hard to make up time when I barely have enough time to begin with. If a patient needs to be admitted to the hospital, then there is no hope of staying on schedule. All the while, you know that in spite of doing the right thing, all of your patients are going to be angry for the rest of the day, and long after they are home, you’ll be working on charting, call backs, hospital rounds, prescription refills faxed in from the pharmacy that have to be found in charts, and on and on.

I felt like patient care was getting reduced to clock-watching and a panic-driven pace.

When we moved to North Carolina, I applied for a license to continue to practice medicine here and discovered something unusual about PA practice in North Carolina. If you are not actively practicing for 2 years, your license goes under review and you are required to apply for re-entry into practice. The process is not clearly defined, but the only PA I knew of who had gone through it had to shadow a physician for 6 months before being granted a clear license to practice. That means no income for 6 months. Because I stopped practicing when I became Program Director, my two years is up in the next few months.

So I had a decision to make: stay in academics and lose my license to practice in the next few months, or go back into clinical practice.

In September, I got a call from the practice that is the gold standard of physician home-visit practices in the nation.They see adult and geriatric patients in their homes and in assisted living facilities. There is no time crunch to see patients, as patients are seen within a window of time, as they wait in their own homes making dinner, reading a book, or watching their favorite TV show without being exposed to other sick people. I would see the same number of patients in a week that I have previously seen in a day. I’d work out of my home, but I’d have lab and radiology staff, and an online support team. I’d carry my “office” with me in a rolling doctor’s bag with everything from vaccinations to suture kits. The schedule would be flexible. It reminded me of John Wesley and how when he made pastoral calls, he and his fellow ministers would care for a person’s physical health as well. I think it’s the way Jesus would practice medicine too — going where the needs are, seeing people in their own homes, taking time to look a patient in the eye and listen.

At the same time as deciding whether or not to move to Ghana, I had to decide whether to stay in academics and lose my license to practice, which would make it very difficult to get a license back, here or anywhere else, including Africa.

Or I could leave academics and go back into clinical practice, which would help prepare me for the mission field by refreshing my skills, and allow me to maintain my license, while practicing in what I feel is a God-honoring way.

One of my favorite residents at Mercury Courts. I miss them all!

After praying about it and consulting with mentors, I am transitioning back into clinical practice. I will still continue to do some guest lectures in the PA Program here, but my focus is going back to clinical practice. I have already started seeing patients one day a week, and I absolutely adore my patients. They remind me so much of the people at Mercury Courts that I worked with and loved for 6 years in Nashville. I love the fact that I have enough time with each patient to appreciate who they are. And I get to live out the gospel through medicine among the geriatric population in preparation for living out the gospel through medicine in Africa.

We had no idea when we moved to North Carolina that God would have so many changes in store for us. The things we thought we loved and depended on are rapidly changing. Jobs, our house, our friends, our financial security — the things we have had any dependence on — are fading in importance compared to the ultimate goal of following where God is leading us.

“But whatever were gains to me I now consider loss for the sake of Christ. What is more, I consider everything a loss because of the surpassing worth of knowing Christ Jesus my Lord, for whose sake I have lost all things. I consider them garbage, that I may gain Christ and be found in him, not having a righteousness of my own that comes from the law, but that which is through faith in Christ—the righteousness that comes from God on the basis of faith. I want to know Christ—yes, to know the power of his resurrection and participation in his sufferings, becoming like him in his death, and so, somehow, attaining to the resurrection from the dead.

Not that I have already obtained all this, or have already arrived at my goal, but I press on to take hold of that for which Christ Jesus took hold of me. Brothers and sisters, I do not consider myself yet to have taken hold of it. But one thing I do: Forgetting what is behind and straining toward what is ahead, I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus.” Philippians 3:7-14, NIV

As we drove past the 339-bed Tamale Teaching Hospital in our Global Partners van, I was amazed at the size and beauty of the structure. The hospital campus was buzzing with patients and providers. Clearly it had been, and is continuing to be, renovated, including the addition of a neonatal intensive care unit. The hospital welcomes students from all around the world to train there, and was voted the best teaching hospital in Ghana in 2013.

My first thought was to of course admire the hospital resources available in the community. Perhaps the medical care situation in northern Ghana wasn’t as dire as I had thought.

Then I started to do some math.

Tamale Teaching Hospital serves the 2.5 million people in the northern region, 1 million people of the Upper West, the 1 million people of the Upper East, as well as part of the region of Brong Ahafo and its 2.3 million people.

It also serves the countries of Togo, Ivory Coast, and Burkina Faso as the regional referral hospital.

More than 6 million people. 339 beds.

Can you imagine a city the size of Toronto, San Francisco, or Philadelphia having only one hospital? Can you imagine trying to get care there?

Even as I looked at the beautiful facility before me, I began to feel the suffocation of health care shortage.

The ratio of physicians to patients is one for every 93,000 in the northern region of Ghana. The question is not as much what will I do, but how will I manage to make a dent in the overwhelming need?

In Ghana, earning the right to practice medicine is an interesting blend of paper and tribal processes. I will need to meet with the Chief District Medical Officer, and first ask to learn about medicine in Ghana. I cannot come in as an expert who is ready to practice. Though I have taken a missionary medical course focusing on treatment of diseases of Africa, I know that there will still be a steep learning curve to understand not only the different diseases that exist there, but the treatments that are available in Ghana. After a time, I will need to return to the Chief District Medical Officer to ask permission to practice.

My desire is to learn alongside the physician working at the SOS International Children’s Village in Tamale. Not only do they treat the orphans that live in their orphanage, but the health center is open to the community. Since the only physician there is male, and Tamale is predominantly Muslim, I look forward to ministering to the health needs of the Muslim women who are prohibited from being touched by a male physician. When we visited the SOS medical center, the waiting room had dozens of people waiting to see the one physician. When I asked if I could shadow and volunteer, a look of relief spread over the face of the administrator. The answer was a relieved, “Yes.”

My heart though, is still working to address the health care needs beyond just myself. I simply cannot meet the needs of 93,000 people by myself. I can barely make a dent.

My dream is to eventually move beyond making a dent to helping develop sustainable programs to address medical needs, especially in rural areas. We have learned much from the Ebola crisis in Sierra Leone about the need for training community health leaders who can disseminate information, treat basic diseases, and know when to refer to larger medical centers while they can still be treated. I hope to use the networks of The Wesleyan Church in Ghana to raise up leaders to help meet the health needs of their communities. In the future, I would also love to welcome students, medical personnel, and other volunteers from the United States and Canada to help provide training and practice to meet the enormous medical and spiritual needs in northern Ghana.

In some ways, I realize that this may sound less than spiritual. But as I look to scripture, I am fascinated by the role that healing the sick played in Jesus’ life and ministry.

Matthew 10:7-8 says, “As you go, proclaim this message: ‘The kingdom of heaven has come near.’ Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons. Freely you have received; freely give.”

Jesus’ commands as He sent out the disciples were overwhelmingly about healing the physically sick, not just declaring spiritual truth. One fifth of the gospels is dedicated to the healing miracles of Jesus, far more than any spiritual conversion stories.

Healing the sick is Kingdom work. I may not ever fully understand why medical work is so close to the heart of Jesus, but I am so thankful that I can live out the gospel in such a tangible way.

Ultimately, I will be focusing on ministry through medicine in Ghana, learning and eventually practicing medicine in the northern region of Ghana. I will also be developing programs to improve health outcomes in Ghana utilizing the networks of The Wesleyan Church to decrease transmission of infectious diseases, reduce child morbidity and mortality from preventable diseases, and improve women’s health outcomes.