Thanks for Nothing

It’s funny how time changes your perspective on people, even after they are gone. My grandmother, Grace Story, was born on the mission field in China. Though she passed away over five years ago, I know that she always had a heart for missionaries, since she had lived on the mission field until she was 12 years old. She spoke 5 different languages growing up. She was disciplined, frugal, and could be stern. But oh could she laugh! And oh how she loved Jesus.

I actually never lived close enough to my grandmother to see her on a regular basis. There were many holidays spent together, and the occasional family reunion, but not the consistent contact that many grandparents have with their grandchildren. I don’t feel like I knew her well, or was very close to her. But I do remember how I felt about her.

I remember as a child being annoyed that my grandparents didn’t shower me with gifts, or cash, or much in the way of tangible items compared to what many of my friends received. I got cards containing sentiments, but not cash. Presents, if any, were simple and wrapped in used paper. Who reuses wrapping paper!? Every penny was counted, none were wasted. There was no cable television at their house. Boring! The air conditioner would not be turned on in the car. Unless I had heat exhaustion and I threw up. Which I did. Even flushes of the toilet were carefully guarded. As odd as it may seem, that is what I remember most about my grandmother as I was growing up. Wishing I could squeeze just a little generosity out of the matriarch of the family.

As an adult, and loving geriatric patients, I now understand a bit more about my grandmother, having gone through the Great Depression in her young adulthood. Being frugal had become a lifestyle that would not be erased over time. Her excruciating frugality was a difficult and chosen lifestyle, which I can now appreciate.

It wasn’t until her funeral that I found that there was even more to Grandma’s frugality. She gave sacrificially to missions, not just financially, but in hours spent at the typewriter writing letters. She took extra jobs cleaning boarding houses or picking berries to earn money for mission pledges. In fact, we found that my grandfather had saved money secretly for retirement, because if she had known about the money, my grandmother would have given it away to missions. What I had perceived as a lack of generosity was actually more generosity than I could imagine — giving away every single spare penny to missions.
Looking back through the lens of time, I realize that the birthday cards that didn’t carry cash, the simple Christmas gifts, the carefully counting of pennies weren’t because of a lack of love. They were because there were people around the world who needed her generosity more than I did, and her few dollars helped to bring the gospel to those who needed to hear. How many souls is she meeting in heaven now because of her frugal generosity? I’m quite certain there is a long line because indeed, Grandma died rather penniless.

Thank you for all the empty cards, the crumpled wrapping paper, and the meager gifts, Grandma. It was money well spent. I hope you know that those gifts of nothingness have inspired me to live out the dream you were never able to as an adult: to go to the mission field.

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What I Hope to Take from Africa

My adoration of the people of Africa started over 20 years ago. In my Interpersonal Communications class that I took in the spring of my sophomore year in college, there was always one student I wanted to partner with. Her skin was the deep richness of milk chocolate, she carried herself regally like a gracious but exotic queen, and her deep voice had a crisp and clean accent. Some consonants were accentuated. Others were barely spoken. The beauty of her speech made me want to sit and talk with her whenever I could. Her African accent still wafts through my mind.

 

IMG_1290Nearly four years ago, when we sought after what countries were most in need, and were easiest to process through, we came upon the Democratic Republic of Congo. The richest country in the world in terms of natural resources, but nearly the very poorest in terms of average personal income. The world is enamored with its treasures, but is disrespectful of its people. It’s broad-nosed, full-faced, beautiful people. Our hearts melted for the overwhelming poverty, and its youngest victims, the thousands of orphans within its borders. We brought two of them home to live with us.

 

More recently, my first day on the job at DMHC in December, I walked into the medication room at an assisted living facility, where the staff was hard at work. Three women were busily chattering, but two of them had melodic voices and the same crisp syllables. They were a bit different from each other, but beautiful nonetheless. When there was a break in the conversation, I had to ask, “Excuse me, but may I ask where you are from?” One replied, “I am from Kinshasa in the Congo,” and the other replied, “I am from Accra in Ghana.” I hugged them both. And then I explained why. By the end of the day, they each promised to move to Africa with me.

 

As I was walking down the hallway at work last Saturday, a tech was talking to another. I immediately interrupted and said, “I’m so sorry to interrupt, but where are you from?” She smiled and said, “I’m from Accra, in Ghana.” I squealed and hugged her as I showed her the Ghana map pendant that I was wearing around my neck.

 

When Paul Borthwick, author of Western Christians in Global Missions, was traveling to Nigeria, he met a young man named Robert. He recounts in his book,

 

“Robert, how did you become a Christian?”

 

He replied, “Oh, Brother John over there raised me from the dead.”

 

After recovering from my surprise, I asked him, “Why do my Nigerian friends see more miracles than we do in the United States?”

 

“You have more doctors,” he replied matter-of-factly. “If God doesn’t heal us, we die. You just have more doctors.” Using good theology, he concluded, “God heals you one way, and he heals us another.”

 

The church that is dependent on Jesus sees God’s power in a way that a church that is dependant on itself does not.

I’ve thought of all the things that I want to bring to Africa. I hadn’t given much considered what Africa could give to me. Right now in Africa, people are being miraculously healed, while I depend too much on my diagnostic and prescribing skills. God is calling African people to Jesus through visions and dreams, while I worry about saying just the right thing at just the right time to those around me.  In Africa, people are seeking Jesus by finding a Christian and asking the believer to lead them to Christ, because God Himself has laid the gospel on their hearts — not an television evangelist message, Christian concert altar call, newly constructed building with ample parking, or outreach event with the gospel slipped in between the lines to not be too offensive.

 

The stories we read about with awe in the Book of Acts are still happening in Africa today. No one has told the Christians in Africa that these things just don’t happen anymore.

 

They wouldn’t believe it anyway.

 

I want to experience Christianity unpolluted by time and progress. I want to depend on the Holy Spirit for my work, and for my witness.

 

If current trends continue, Africa will be the most Christian continent by 2025. The average Christian is now no longer a Caucasian of middle class status, but a poor minority woman from the southern hemisphere, most likely from Africa. I am excited to witness first-hand the shift of Christianity to a non-American religion, and help the Africans to lead the way by example.

mission-cemeteryPaul Borthwick also talks about early mission work in Ghana. When he visited the country, he was taken to a missionary cemetery where he saw the graves of many British missionaries who died at the age of 25 or 26. In fact, missionaries just a century ago would pack their belongings in caskets rather than suitcases because they fully expected to die on the mission field. And they did– most of them after only a short time of planting the seeds of the gospel. But the seeds they planted are still growing. I am convinced that their radical sacrifices are still bearing fruit as the gospel continues to spread like Holy Spirit-driven wildfire. I believe God honors our decisions to do hard things, even if we never see the rewards ourselves.

 

My adoration of the people of Africa has blossomed into a desire to serve them, and to learn from them. How fortunate I am that God has called me to be a witness to what He is doing among them!

Why I’m Not Going to Ghana on a Short-Term Medical Mission Trip

The glassed-in room could barely contain the anxiety of the suit-wearing prospective physician assistant student in front of me. Just me and the candidate. I had 7 minutes to size them up.

My question of the candidates was the same for each, as much as it was for me. I asked them a question that was plaguing my own heart. It was a question posed by Palmer,

“Why are there so many doctors in America, and not enough in Africa?”

I honestly didn’t expect the applicants to have a well-thought out answer, but I wanted to listen to them process the disparity. I wanted to hear them wrestle through the thoughts that I was having.

I wondered if this conversation might be a flash forward to one day when I appear before God’s throne, and He asks me the same thing.

“Why were there so many doctors in America, and not enough in Africa?”

The answers from the candidates were varied, but all laid the responsibility at the feet of the Africans.

“The people in Africa just need to pull themselves out of poverty.”

“They just need to get an education and become doctors themselves.”

I reminded the candidates that in Congo, the average income is around $400 per year, and sending a child to school costs more than that. Their annual income couldn’t even meet what is needed for food, clothing, and shelter, much less medical care and education.

Candidates would predictably turn to international aid.

“We should send short-term missionaries to help them for a week or two out of the year, and I plan to do that,” was the near unanimous reply from dozens of applicants.

I would challenge, “What about the other 50 weeks out of the year? Who will care for them then? What if they have an allergic reaction to a medication? What if it doesn’t work or they can’t get more? Who will follow up with them?

The students would then go back to the same struggle.

“Well, maybe you could coordinate teams so that a different team would be there every . . .” Their voices would trail off in realization of the massive logistics.

How would medical language be translated effectively? How would short-termers know the cultural implications of their treatments, or if patients could even afford them? What if the provider wasn’t well-versed in tropical medicine and missed the diagnosis entirely? How would we feel if a Russian doctor flew in for a week, popped up a tent in the parking lot, and started to see patients for free in our local town without knowing language, licensing, culture, or medical logistics here?

My final question was this: Who is responsible for making sure that the underserved around the world get access to quality health care?

Most agreed that someone should go long-term.

Someone.

Most agreed that that someone should be someone besides them.

And then it was time for them to move to the next station. And time for me to interview another candidate.

Only a few weeks later, Ken and I returned from northern Ghana, where the number of medical providers is even fewer than in Congo. As we sat sipping coffee in Charlotte, we asked ourselves: Could we accomplish the same goals by going short-term several times a year? We could keep our house, keep our kids in the nice school they are in, and have minimal disruption to our lives. It would be easier.

How many patients can know the love of Christ if I only see them once? How many health care workers can be trained if I am in and out of the country several times a year? How many new believers can be mentored in their faith? How can we be competent in understanding the culture, Ghanaian medical practice, local language, and have meaningful relationships with just a few trips a year?

My mind flashed back to the struggle in that interview room that every prospective student had, trying to balance the logistics.

Someone needs to go long-term.

Are some called to go short term? Absolutely. But without someone there long-term, there cannot be others going short-term.

Clinic IVIn a year where short term medical mission trips, dollars, and interest are at an all-time high, mission hospitals and clinics around the world are struggling to operate and remain staffed as mission dollars are being spent on short-term trips, rather than long-term investments.

When we were in Ghana, we visited a Wesleyan clinic on the outskirts of the capital of Accra. The clinic staff that we visited had not been paid in weeks, and yet I was trying to convince them to allow short-term students and volunteers to come and “help,” in spite of the fact that they were fully-staffed and open 24 hours a day, seven days a week.

Clinic staffHad I asked those staff members if they would rather have someone spend $4000 to come on a short-term mission trip or donate $4000 to the operating expenses of their clinic, what would their answer have been? As much as short-term help can be such a boost, it cannot replace those who are there long-term, and in some cases, it can cause the locals to lose their much-needed jobs.

If every dollar spent on short-term medical trips were matched by dollars spent on long-term investments, medical missions could be radically transformed into sustainable ministries with continuity and higher standards of care.

Maybe we should at least give the option to the people in developing countries we are seeking to serve: What would a financial contribution in the amount potentially spent on a short term mission team do for your organization? Which would your organization rather have? It’s not as sexy to send money anonymously as it is to go– there are fewer pictures and safaris and stories to tell, but perhaps the field should be given deference to the work they are already doing, and the needs that only they know about. Maybe missions shouldn’t be as much about our needs as theirs.

As I sat in the room with the PA student candidates, as I asked the unpaid staff in the Wesleyan clinic in Accra to take American volunteers, as I sat in the coffee shop in Charlotte, I realized that I needed to put the needs of the field first. And what Ghana needs is my investment long-term in learning medicine, language, and culture to provide medical care in the name of Jesus to unreached peoples, and to build sustainable medical ministry by training local Wesleyans to provide basic medical care in their own communities.

To do this, someone has to go long-term.

 

And that someone is me.

Shea Butter Story

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!

Indignation at the Incarnation

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.

Nativity with text

Straining Toward What Is Ahead

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.

DSC04420 - Edited

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

Making a Dent: Plans for Medical Ministry in Ghana

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.

photo 3My 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.