Thursday, October 9, 2014

I want to comment on something I saw on the Huffington Post, by Larry Liske, the director of Prison Fellowship, founded by Chuck Colson.  Partly I do this to illustrate that my rantings have much-needed applicability in my own tribe--not just in the Tanzanian bush.  Below is what Mr. Liske postulates in an article entitled: "Restoring Dignity to Criminal Justice."  While I agree with him, I want to go deeper:

When he signed the 1994 Crime Bill, then-President Bill Clinton called it the "toughest and smartest crime bill in our history."
Since then, the violent crime rate has dropped, but it's not clear that the Crime Bill is responsible. A number of changes -- including improvements in policing, the waning of the crack epidemic, and the aging of America -- also play a part. What is clear is that the crime bill has helped put 2.3 million men and women behind bars, and with millions more on probation or parole, we are the world's leaders in locking people up.
Why should we care if more criminals are behind bars for longer sentences? As president of the nation's largest outreach to prisoners, ex-prisoners, and their families, I've seen the downsides of mass incarceration up close. People who could safely be returned to the community remain behind bars for years -- at a hefty cost to taxpayers. The 2.7 million children with an incarcerated parent are the most at-risk children in America, subject to depression, anxiety, poverty, home instability, substance abuse, and gang involvement. And the lack of rehabilitative programming leaves the 700,000 prisoners released every year prone to commit new crimes, which means more victims.
Like a football coach who fine-tunes his game plan at halftime, it's time to introduce a more pro-active crime prevention strategy. Without compromising the public-safety gains of the last 20 years, we can focus on bringing good people home -- not just keeping those who break the law locked up indefinitely.
Every day, former prisoners can and do come home completely renewed and restored, prepared to help build safer communities, and actually be part of the solution to crime. For examples, I need look no farther than my friend Edwin, who came out of prison to build a successful business in Michigan that employs other ex-prisoners, or Tish, a former addict who became a model mother and addiction recovery counselor, and Chuck Colson, who founded Prison Fellowship after serving time in a federal prison. There are countless others.
We can help create more success stories -- and safer communities -- through policies that respect the human dignity of each life, recognizing that "criminals" are not a monolithic group of monsters. They are people, capable of choosing to change and contribute. Some people who commit crimes will choose not to change, and in the interest of public safety, they need to be separated from society. But for those who can be restored, and have paid their debt to society, shouldn't a second chance be possible?
There are many ways to respect human dignity in the criminal justice system without putting the public at risk. Drug courts, mental health courts, and veterans' courts address the needs of populations best served outside the main criminal justice system, and they do it more cheaply and effectively. By dealing with the complex issues beneath many crimes, like addiction, mental illness, and post-combat trauma, alternative courts help keep new crimes from occurring. The nation's first veterans' court, in Buffalo, New York, had a zero percent recidivism rates in its first few years -- none of its participants committed a new crime. Alternative courts -- aiming for rehabilitation instead of incarceration -- are springing up in states across the country.
Within the corrections environment, let's bring prisons back to their morally rehabilitative purpose. Prison Fellowship and other volunteer-driven organizations provide proven programming behind bars, addressing criminal thinking and behavior at the root. Innovative corrections officials, like Louisiana's Warden Burl Cain, can also create environments that support life transformation without compromising safety.
And we need a reentry environment that allows those who have served their time to make a new start. At the federal level, the Second Chance Reauthorization Act, now making its way through Congress, would extend programs that help returning citizens re-integrate into the community through partnerships with state and local government as well as faith- and community-based organizations. Just a couple of initiatives receiving grants from the Second Chance Act include a Texas program for gang-affiliated teenagers, which is helping them stay out of jail (Kathleen A. Fox, Vincent J. Webb, Alejandro Ferrer, Charles M. Katz, and Eric Hedberg, Gang Intervention Treatment Re-Entry Development for Youth (GITREDY): A Report on the First Year of Implementation (Huntsville, TX: Sam Houston State University, 2012), and a mentoring program for mothers being released in Oklahoma, which had a 98-percent success rate at keeping women from returning to prison over a 12-month period (figures are as of September 2013. Recidivism is defined as a return to Oklahoma Department of Corrections custody).
There are many ways to keep us safe. Our representatives need to know that we support proven alternatives to mass incarceration that help restore individuals, families, and communities. When President Clinton signed the Crime Bill, he commented, "This is about freedom. Without responsibility, without order, without lawfulness, there is no freedom." I would add that there is no freedom without respect for the dignity of each human being. It's time for that respect to be enshrined in the criminal justice system, for all our sakes.

Below is my response, the old, "Beware the technological solution for the moral problem."

I agree with Mr. Liske by and large. His suggestions certainly seem to be steps in the right direction. However I still think they are superficial solutions to deeper problem. They might be called "technological solutions for a moral problem." That doesn't mean they are bad. I just means they are insufficient to accomplish the whole. They don't go deep enough.

For the last decade I've served as a physician to thousands of inmates in some of America's toughest prisons. I have deeper and more difficult questions: How did we as a culture arrive at our current posture towards prisoners? Why do we do what we do, and why isn't it working? I submit that the problem is an issue of identity. We don't know what it means to be a human person, or what human flourishing looks like. Or if we do know, we are afraid to say so in our relativistic culture. Mostly we think everyone should get to choose every facet of their identity and self-determine what flourishing looks like for themselves. Unless we can discover a consensus on, "Who is a human person?" we will fail to answer the question: "What ought we to do to help human persons flourish?" For inmates, the question essentially is, "How do we help this person walk in restoration?" 

Restoration in the lives of felony offenders IS possible. Like Mr. Liske, I've seen it too. I bow in respect and gratitude to Mr. Liske and the work of his organization. But I still want to see Americans engage with these deeper questions. We can and should do Mr. Liske's suggestions.  I'm an incrementalist; though his suggestions don't go strike at the heart of the problem, they are steps in the right direction and should be embraced.  But dare we dig deeper?

Friday, July 25, 2014

Series: Technology, Morality, Power, AIDS Part VI of VI: Morality


What does this have to do with AIDS and ARVs?  AIDS is a frightfully powerful phenomenon.  Perhaps the best response to it is not to play its game—to try to overwhelm it with natural power.  Perhaps the best response is not a technological response, but a moral one.

Though they are of course technological, ARV’s are a good thing—a gift. They are saving the lives of millions. They are reducing transmission rates of HIV.  They have their place and they most certainly should be used.

But there are many today that believe that through the power of ARV’s, Africa may possibly be free of AIDS in a generation.  Two years ago, the cover of The Economist, a widely read and respected periodical, read: “The End of AIDS?”  The writer went on to explain why he and many of his persuasion think that because of new ARV technology, AIDS is all but beaten.  I question this.

If ARVs are so powerful, why in America, where we have all we want of the newest and best, are we still diagnosing new cases of HIV? There are new infections all the time.  As described above, I diagnose new cases in prison, a setting where free ARVs of the highest quality are physically handed to AIDS patients by a nurse twice daily. Despite the pinnacle of development and delivery of this technology, AIDS is hanging on in America despite the fact that ARVs are readily available and generally “free” to the patient.  (Though they must exist, I have never met an AIDS patient who pays for his own drugs). Pharmaceutical companies are spending hundreds of millions developing new drugs.  Would they be doing that if they expected AIDS to disappear?  But these are superficial arguments.

Five percent of the children in a typical African village are malnourished, even during harvest time, when food is plentiful in the community.  At this very moment, there are malnourished children waking up in homes within a few miles of where I sit.  What is the solution for malnutrition?  It’s corn and beans.  That “technology” has been around for millennia, and is manufactured right here in the village in large amounts by local people.  Yet malnutrition remains a common cause of death.  If less than 100% of the people are getting food, which is cheap and grown in the village, how can we expect 100% of the people who need ARVs to get them?  Simply delivering technology to people is not as easy as it may seem.

We have pushed condoms as a solution for AIDS for over two decades. The approach has largely failed.  ARV’s do a good thing.  They often keep an infected person well.  That person may live a long life.  ARVs should in no case be withheld from an individual that could be helped by them.  But the person who claims that ARV’s will be the end of aids is hoping that ARV’s will dramatically reduce the rate of new HIV infections—because for it to be truly the end of AIDS, that would have to happen.  ARVs are, in a sense, chemical condoms. Except for a few major differences: they are much more expensive, they have more and worse side effects, they are more dangerous, they are rarely manufactured on this continent (they have to be shipped in from elsewhere), they are less well understood, are harder to store, and are harder to manufacture and distribute.  Is it safe to assume that ARVs will be more successful than condoms have been?

And there is another difference that is pointed out to me by Africans all the while.  It used to be that you could at least tell who had active AIDS because they looked very sick.  With the advent of readily available ARV’s, now many people who are HIV positive don’t look sick. People who are seeking sexual partners cannot easily tell whom to avoid.  Now people fear that new infections will rise, because the promiscuous are taking risks without knowing it.

Morality actually could eradicate AIDS in a generation.   Abstinence before marriage and faithfulness during marriage have done tremendous things to decrease HIV rates in places such as Uganda.  Morality is inexpensive, has good side effects, doesn’t have to be manufactured, stored, or imported, and most importantly, comes from within the people themselves.

Morality is the resignation of the power of the "kingdom of self".  It is submission to a supremely good higher power.  God’s power in peoples lives, His empowerment to behave the way he has instructed us, really could stop AIDS.  Think about it.  What if people were faithful?

Please don’t misunderstand me.  Widespread use of ARVs is not a bad idea.  They absolutely have their place in stemming the tide of AIDS. But they cannot stand alone.  One of my frustrations in the last ten years in Africa has been how hard it can be to get ARVs in the village.  I wish we could get them.  I would not wish that if I thought they were foolish.  But I do think that hoping in ARVs as the end of AIDS is totally na├»ve. Just as Man is much more than just a physical body, HIV is much more than just a virus.  Reality is more than it seems, not less.  The solution is going to have to go a whole lot deeper than just a bottle of pills.

Beware the technological solution for a moral problem.

Wednesday, July 23, 2014

Series: Technology, Morality, Power, AIDS Part V of VI: Beware the Technological Solution for a Moral Problem

Beware the Technological Solution for a Moral Problem

A hero of mine has said, “Beware the technological solution for a moral problem.”  I have come to understand that this is one of the deepest problems in Africa—and America.

What does this mean?  Technology is a way of exercising power over the natural world.  So is shamanism (witchcraft).  This is front and center in Africa.  For example, I was just informed this morning—in earnest—that if you wear a necktie to church, you will receive more blessing.  Stethoscopes and white coats impart the same magical power: your doctor is most powerful when he uses these charms.  The necktie, the stethoscope, the white coat: talismans?

How should morality be understood?  If technology and spells and amulets are about power, what is the relationship between morality and power?  I’m honestly trying to make sense out of this.

Intuitively, I know that morality is not about exercising power.  With technology, you discover power in something, appropriate it, and manipulate it for your own ends.

Is morality actually about resigning the right (read, demand of the flesh) to exert natural power?

I have taken a week to think about this.

Consider the motivation and actions of Judas Iscariot, the Jewish leaders, and the Roman rulers.  These are all about exerting power in the natural world.  As their machinations begin to unfold, Christ preempts their power play with a resignation of natural power. Assuming the position and posture of the lowest slave, He washes His disciples feet at the Passover.  This is anti-power.  Which is why it so shocks Peter and the others.  They expect Him to exert power, and they can’t help assuming it will be natural.  Peter reverts to this reflex when he amputates the servant’s ear in the garden.  But Jesus works in exactly the opposite way.  Instead of grasping at power, he surrenders it.  

The cross—perhaps the ultimate moral act in all history—is anti-power.  Jesus refuses worldly power.  Instead He submits to supernatural power.   On the cross, He imparts His righteousness—His moral rectitude—to all His children.  True moral rectitude is not natural.  It is not natural to man and it is not attained through natural means.  It is supernatural.  Man striving to be good and right by his own natural power is a failure called legalism. True morality is resignation of my own natural power, and the submissive acceptance of the Father’s supernatural power to do and be good.  Jesus is a picture of this during his passion: the Passover, Gethsemane, His trial, and the cross.

Tuesday, July 22, 2014

Series: Technology, Morality, Power, AIDS Part IV of VI: A Tough Conversation

This is a conversation I’ve had too many times—in prisons, where at least I could offer medications, in Haiti where nothing was available,and numerous times over the last decade in African villages—during the time span from 'no access to medications' to 'greatly improved availability.'

I think I’ve cried every time I’ve had to tell a patient this harsh news.  God just made me that way.  I cry easy.  I guess (and hope) patients take it at face value—it’s just compassion.  I feel their pain—some of it anyway.  It is a big deal, so it’s not like crying is inappropriate exactly.  It’s just that I’m pretty sure that most
doctors don’t cry so much.

Antiretroviral medications (for the HIV virus) have exploded on the scene in the last decade.  In remote Kenya in 2006 we had to go to great lengths to get them.  By 2007 it was easier—we unloaded a box of them from the plane once a month.  But even in 2007, the clinic was paying for them out of their own budget.  Generous missionaries were paying for the pediatric patients.  I won’t forget those two little girls.  They brought my Joi three giant white land-snail shells from the forest—nearly as big as baseballs.  We keep them on a shelf in our home. They remind me to pray for those two little girls—and wonder if they are still alive.

By now, even in remote Tanzania, I know that I could have HIV drugs in my hands within two hours if I needed to. But I’m a mzungu (white person) with money, knowledge, and access to a car.  Our little clinic here still doesn’t have them.  We are waiting for the government to make good on their promise to provide antiretrovirals (ARVs). The clinic here just can’t afford them.  There is a government clinic eight kilometers away that sometimes has them.  For now, we send patients there—or into the city.  Even so, I’m amazed that they are available at all. Africa is changing rapidly.

Series: Technology, Morality, Power, AIDS Part III of VI: Maximum-security prison, USA, 2010

Maximum-security prison, USA, 2010

“James, you know how we did those tests two weeks ago?”

“Yeah.”  James was about my age.  He’s African American.  Though he was dressed in the denim and orange typical of prisoners, and had no access to real makeup, he managed to look pretty feminine.  His mannerisms and speech were very effeminate—a sharp contrast to the leg cuffs, handcuffs, and lengths of chain that bound him.

“Well, I’m really sorry to have to tell you this, but the HIV test came back positive.  You have HIV.”

His jaw dropped.  Silence.

“You mean, like, I’m gonna get AIDS?”  Tears began to flow.

“AIDS is what we call it when the HIV virus makes you sick.  I don’t know if it’s ever going to make you sick.  We are going to do some more tests, and figure out if you need to take medication now or if it’s better to wait.  If you take the medication, it might prevent the virus from ever making you sick.  You might even live a normal life span. We don’t know yet.  But lots of people that are HIV positive are living with it—living fairly normal lives—for decades.  We will just have to see.  Whether you start on the medicine now or later, we are going to have to do blood tests to check in on how your body is handling it.  We will do those about every three months.”

“Well, how’d I get it?  I mean…” he trailed off.

I was kind of hoping he wouldn’t ask—that it would be obvious to him. I guess it was, but he asked anyway.

James continued, “I mean, yeah, like I have had a lot of 
partners in here… But I just… I just didn’t think I would get it.  You think that’s how I got it?”

I nodded.  “Most likely.”  I was grateful I had not had to say it.

His tears burst out afresh.  “How am I gonna tell my mom?!”  He bit his lip.  “She doesn’t even know about me… that I have sex with men!”

I had no answer.  I answered a few questions about whether the test was reliable and other medical minutiae.

“I tell you what.  You’re gonna need some time to think about this. Take half an hour.  The nurses have a room back here where you can sit and think.  Maybe pray, if that’s something you do.  And I’ll be back in half an hour and answer whatever questions you have.  And I wanna see you back next week too.  You’re going to have some more questions. And I want to check in on you and see how you’re doing.  If you want me to pray with you when I come back, just say so.  You OK if I go now and talk to you in about half an hour?”

He nodded.

I tried to make sure that the nurses wouldn’t be able to tell that I’d been crying a little bit.  Prisons are not places where doctors typically cry with their patients.

Saturday, July 19, 2014

Series: Technology, Morality, Power, AIDS Part II of VI: East Africa

East Africa, 2007:

“Mama, we have the medication for your girls, and they seem to be doing well.  But I’m worried about you.  You are very ill.  The medicine doesn’t seem to be working as well as it did before.”  I tried to keep the language simple—for the sake of my interpreter and for the Mama.  She was a widow.  AIDS had already claimed her husband.

As with the woman in Central America, I suspected that the husband had been unfaithful while working out of town, and had brought the dreaded disease home.  But in this case, the demon had its claws into the children too.  It was heartbreaking.  She was too sick to work anymore.  She survived on the charity of neighbors and missionaries.

“How long will I live?” she asked quietly, meeting my gaze.

“I’m not sure.  Maybe a year.  Maybe more.  Maybe less.”

“The girls?”

“They are doing well.  They could live a long time.”  I honestly had no idea.

The unspoken question hung in the air, “What will happen to my children?”

“What can I do?” I thought.  “In a month, I’m going to be back in
America.  I may never be in this village again.”

We sat in silence.  Eventually I offered to pray with them, which they
accepted graciously.  “Come to the house,” I offered.  I turned to the
children, “Mama (my wife) has some sweaters to give you girls.”  I
hoped my smile seemed genuine.

“I’ll see you next week?” I said to their retreating backs.  Mama
looked over her shoulder and tried to smile.

Monday, July 14, 2014

Series: Technology, Morality, Power, AIDS Part I of VI

Remote Central America, 2003:

Sweat ran down my forehead and dripped from the tip of my nose.  But the family facing me in the dim light of the tent was decidedly more uncomfortable.  “How do I say this?” I wondered to myself.  “Lord, help me!” I prayed silently.

I took a deep breath and continued, “Senor, the test shows that you have the HIV virus—the virus that causes AIDS.”  I waited for the interpreter to communicate this news.  His face barely changed.  He knew already.  I thought so.  His wife turned and studied him.  The children huddled into the protection of their mother’s bosom.  I turned to her, “Senora, you have it too.”

She burst into tears.  Through my own tears I gave her the good news, “Both of the children tested negative.  They don’t have it.  And they won’t catch it from you.”  She hugged them tighter and put her face between their grimy heads, uttering something I couldn’t catch, probably a prayer of thanks.

I turned back to him, “Senor, we have some antibiotics which may help you for a few days or even longer.  But you don’t have long to live.”  Still he hardly reacted.  Maybe he felt too sick to react.  Surely he was weak.  He had been more or less been carried into this tent clinic in a dingy slum.  Slowly he turned and met his wife’s eyes.  His gaze strayed to his young children.  I went on, “I don’t have any medicine for AIDS.  And I don’t know where to get any.  I wish there was more than I could do.”

No one moved.  He looked at the dirt.  She wept silently and smoothed her children’s hair.  They stared wide-eyed, frozen.  I just sat there.  I prayed silently and felt helpless.

“Senora, you could like a long while still.  You don’t have any symptoms, and that could last for some time.”  I wondered if I should tell her that it was possible that there would be medicine available before she got sick.  I didn’t really think it was very likely.  I didn’t want her to give her false hope.  “You should check in with the government clinic in the city every few months.  If they get medicine, then maybe you can get treated.”

I kept praying.  I didn’t know what else to do.  I asked if I could do anything of if they had any questions.  They were too shell-shocked to talk about it.  Though there were other patients waiting, it didn’t seem right to get up and leave.  We sat silently for a long time. 

I wondered what was running through the mother’s head:
“Who will provide for us?”
“Where will get money?”
“How soon will I get sick?”
“Will I even be able to raise these children?  Will someone else raise them?”
“Will they be OK?”

After some time, a local pastor and a few others from our team gathered around them in the tent and prayed for them.  I wasn’t the only one with tears and sweat intermingled on my shirtfront

Sunday, July 13, 2014

Week 2: Campbell and VCOM students together at City of Hope

Here we are! And almost halfway through our time here at the City of Hope! The group of first-year med students from Campbell was joined three days ago by our VCOM students. So our other half is here, and the ratio of extroverts to introverts has been irrevocably changed (for the louder!). The decibel level of nightly conversations and card games has gone up considerably, but so has the uproarious laughter count.

Our first week here gave us plenty of time to acclimate and get used to Tanzania time… being in Africa means that hardly anything happens on time and, surprisingly, we love it. All of us feel like we are detoxing from the pell-mell, Western medical world. When we got here everyone’s first questions were about what we were going to be DOING. You can imagine how disorientated these task-driven Westerners were when they didn’t have a to-do list for their free time or a normal classroom for our discussions. Ty leads our daily class times underneath the acacia tree in the quietest corner of the compound. So each morning after breakfast there’s a long parade of students carrying their plastic chairs on their heads down to the Lion King tree, form a circle (the circle of life?) and our day commences.

Our time always begins with devotions. We have been working our way through Luke, in no particular order, guided by the Holy Spirit and the profound questions of whichever small group leads us that day. The VCOMers jumped right into the routine and yesterday’s discussion on suffering was especially deep (or dope, depending on who you ask).

Class time follows. The Campbell students bore the brunt of adjusting to Ty’s teaching style last week. And…they LOVE it. It’s not your usual lecture. Instead of spoon-feeding us information he poses questions to help his students rethink their assumptions about spiritual, soul and physical health on their own. In the past couple days we’ve really begun to dig into the worldviews that influence the majority of these future doctors’ patients. It’s not just about patients, it’s about people. The goal of all our discussion times is not to try to teach the students to integrate/insert their faith into their practice, it’s to expand their understanding of their faith so that their practice of healthcare will fit into it. The implications are practical, personal, social and spiritual. It’s good stuff!!!

To break up all the serious worldview talk, there have been a couple hysterical aspects to our mornings. In the middle of conversations grappling with suffering and the will of God, we often find ourselves interrupted by a neighbor’s cow that stays hidden behind some nearby bushes.  We’re convinced he was raised by donkeys. Have you ever heard a cow try to hee-haw? Well, use your imagination. It considers itself an integral part of prayer time…

Then there’s the swarm of African killer bees that decided it would start forming honeycomb on the acacia tree the second day we were here. We woke up the whole hive when we set up shop underneath the tree that day…  luckily they took off in the opposite direction. But we got plenty nervous. Apparently this is the same bunch that almost killed Ty a couple years back when he tried to take their honey. You’ll have to ask him about that one day…

Another local creature that hates Ty is the resident Holstein bull that freely grazes in the compound everyday. (Why they have a Holstein bull and no herd, I don’t know. As far I’m concerned, it’s free range beef, and we all know what that means.) He has a crazy eye and I don’t think he can see that well. I’m pretty sure he gets surprised when he sees us, and since bulls don’t have the flight instinct, FIGHT it is. He paws the ground and threatens us with a good bout of grunting. He has caused the circle to scatter on numerous occasions. I’m not sure that a bunch of white girls running away in brightly skirts has been all that helpful in these situations, but Mr. Bob, a good friend, has now resorted to bringing a 10 foot staff to our Bible studies in order to ward off the beast.

Other than that, we are busying ourselves with relationships and…not "DOING" much of anything. That’s the point. We are learning how to be and how to be ok with not “doing” something every minute of every day. To quote the vivacious and beautiful Erin Fitzpatrick (a Campbell first year) “well, I’ve spent maybe one hour in the clinic in the past two weeks, but I’ve learned more about healthcare here than in any other setting.” Our afternoons are open—open to conversations and time with the children, local villagers, workers, Bernard, Mama Jane, Dr. Ben (the amazing Kenyan man who runs the clinic), the Chacha family, and each other. Then there’s banana farming, corn-crib building, hymn singing, and our latest venture – runs with some of the older girls (I can’t explain how countercultural it is for that group of girls to go running through the village in the morning in all their skirts. Sunrise this morning with them was great.) Nights hold a lot of cards and epic dance parties (shout out to DJ Chacha!) with the kids. Weather is perfect, food is filling, people are beautiful and our God is good. Bwana asifiwe! (Praise God!)

And that’s the update from us! Hopefully more to come, although internet is persnickety…. For now, kwaheri! (Goodbye!)


Tuesday, July 8, 2014

Week one update

For those who are interested in news from Tanzania: We've been here
for a week and everyone is happy and well.  The only thing that has
gone wrong is there are still four pieces of luggage missing.  The
students are very engaged in learning a biblical understanding of
health.  The Holy Spirit has been faithful to encourage us and show us
truths in scripture.  Last week we enjoyed having five Kenyan students
in the seminar.  In two day, seven more students from America will
arrive.  We look forward to their safe arrival.

Tuesday, July 1, 2014

The simple and the holy

An update from Kristy
Kristy is a Blacksburg native and U of Richmond graduate currently living in Blacksburg.

"Good morning all!

We arrived safely in Nairobi last night after the shortest layover in history-- an outright sprint as we caught our connecting flight in London (of course security saw fit to empty at least two of our backpacks as we were passing through!) Unfortunately, not all our bags caught the flight, so we will be having those delivered to the border where we hope to catch them today before crossing into Tz.

We already feel blessed by local believers who are driving us about, and another family which is letting us use their guest house...we were welcomed by chai tea and the Costa Rica/Greece game on -- which I may or may not have stayed up to watch :) it's wonderful to sleep horizontally, and have this place to snatch one last hot shower and access to wireless. By tonight we will be at City of Hope and less able to keep up with email :) There's also a cold snap here in Nairobi, so we are keeping warm. Jeans AND a skirt, thank you very much!

So tomorrow we really begin our time here in earnest. I'm excited for what is in front of us. Yesterday on the plane I watched the Secret Life of Walter Mitty for the first time (spoiler alert). It's a story about a man who had to abandon his dreams for himself in favor of supporting his widowed mother and sister. He works for Life magazine in a dark lower room, processing the photos of those who are "really out there" experiencing life. The movie follows Walter as he tries to find a photographer with a missing negative--the photographer's master work. As you might expect, Walter has many adventures "out there" in pursuit of his friend. He loses his job over the pursuit, becomes a capable mountain man, etc. He gains confidence and relational "weight", sure. But the missing negative was not some elaborate plan by the photographer to help Walter find himself--it was an honest mistake as he had slid the negative into a wallet as a gift to Walter (cute, right?), a wallet which W had thrown out in a fit of disillusionment on his journey. In the end it turns out the wallet is rescued from the kitchen trash by none other than Walter's mom, his plain Jane faithful mom. And what was the master work of this world premier photographer? A portrait of Walter himself, taken from distance as he sat outside his work puzzling over a sheet of photo negatives. That's the master work...Walter in his daily life. And that is what I've realized we are pursuing here. Tanzania is not the proverbial mountain, mission here is not about some grand plan of our making. Rather, it's to see the sacred in the daily..that the daily IS sacred.

It's how God has designed us. We are eternal souls meshed with these wonderfully humble, physical, daily lives. And as we go to humble ourselves, to embrace the daily in all it's simplicity, I think we are going to experience the holy. We will experience the image of God in those we meet and walk together with them as we study what Jesus meant when he said he brought us life to the full. It's not mountain climbing that is the full life, it's going to be found in the daily. And we lean in to seeing our God there this month.

Hope to talk to you soon :) much love!!

Kristy, for all of us"

Monday, June 30, 2014

Foundations of Health and Development Summer of 2014!!

W. on the African coast in March
Pray with us as we send Big T off on a plane to City of Hope for a month. It's the first time he will be traveling without the family, and although it's not going to be as fun, we know he will have an amazing month teaching and learning in Tanzania. And he'll get to sleep on the plane since there won't be any kids to wrangle!

Joining him this month are over a dozen medical students from the US as well as some other special guests (Kristy and Karen) As for what exactly they will be doing this month, I believe Kristy expressed it beautifully in her letter to friends before her departure:

"I'll be traveling with Dr. Ty as he leads a team of medical students to observe, participate and consider what holistic Christian healthcare looks like in another culture. We will explore what health means and the type of wholeness God desires for our physical and spiritual selves, no matter what culture we are from."

Sunday, March 30, 2014

Safari Njema

by Ty, March 25

Today we are leaving the village. It is sad to leave. We really try hard to invest in the staff and the children. Some days it feels like we are getting nowhere and that nothing changes. But every time we return, we can notice positive changes in people. Still, leaving is hard because I feel like I am abandoning people. But at the same time, people need to be left to stand on their own feet. One person at a time, that is happening. We have 13 kids in high school now and they look so sharp in their uniforms. They are the most outstanding students at their school. We are very proud of them. The nurses at the hospital are becoming more competent. We also have a new clinical officer (like a PA). The kids are getting lessons from a marching band leader. Marching and drumming come very naturally to them. Some of the littlest kids show progress learning Swahili and English. Some of the big kids are getting more confident. They don't think they are nobodies anymore. So, while it sometimes seems like slow going, there are signs of hope. I can't wait to see some of these kids go to college.

Tuesday, March 25, 2014


By Ty

We are finishing up 90 days in Tanzania.  Honestly, I am totally exhausted.  For the most part I have really enjoyed this time, but the last week has been very hard.  I have begun to sense a tension—a tension that I think has been there under the surface the whole time, and is just now starting to come out.

I am realizing that I have been guilty of working in my own strength.  I am beginning to understand the culture and the language.  I have started to assume: “OK, I can do this.  I’ve got this.”

But the truth is I can’t.  And even if I could, I shouldn’t do it in my own strength.  I shouldn’t trust in the arm of the flesh.  How could I be what this community needs?

I am guilty of not asking the Lord for His help consistently.  I have been trusting the strength of my own flesh, and now, after 90 days, I sense my strength failing me.  And it doesn’t feel so good.  Not at all. 

Not just disappointment in my own inability—for really I already knew about that.  More like nausea over the vanity of this world.  (I also have a mild case of amebic dysentery, so I am also literally nauseated this morning, which isn’t helping.)

I’ll admit, it’s hard being here.  It is kind of like being in exile.  A preacher whom I admire, Rico Tice, lists the good things in life—the things that we often turn into idols.  He lists: family, friends, food, fitness, fun, etc.  Another illustration I like to use with my students, called the Four Levels of Happiness, names: sex, success, and service.  All of these are good things—blessings the Lord has given us.  And in all of these areas, I make significant sacrifices in being here—I see them much more clearly now than I did beforehand.  I never really realized this til today—not in this way.  Being in exile is hard.

About the only thing I get more of here is time.  And that is a blessing.  Time is the one thing I crave more of in America.  But isn’t it telling (and for me disturbing), that I even think about what “I get?”  Life really isn’t about “getting.”  But that’s easier to say when you are getting.  When you’re not getting—when you are in exile—you miss it.

This realization doesn’t feel good, but I suspect it is good for me.

What I am hearing from the Lord is, “I am enough for you.  Listen to David.” 

Psalm 42 and 43 help.  Some.

Saturday, March 22, 2014

Star Trek, Guns, Thugs, Worldview, and Africa Past, Present, and Future

by Ty

If you ask my Tanzanian boss what is his favorite book on missiology, he is likely to answer with a twinkle in his eye: "Star Trek."  I haven’t watched Star Trek in years, but I used to watch it in high school--both the original series and "The Next Generation," with Captian Picard.  Jean-Luc Picard was an interesting study in leadership and principles.  That’s what made it a captivating show, though if I realized that at all in high school, it was only on an intuitive level.  Captain Picard was a guy who stuck to his principles—most notably, the prime directive, about which he said: "The Prime Directive is not just a set of rules. It is a philosophy, and a very correct one. History has proven again and again that whenever mankind interferes with a less developed civilization, no matter how well intentioned that interference may be, the results are invariably disastrous."  And he made other people stick to principles too.  The storyline of many episodes was built around the ethical dilemmas begotten by the prime directive.  Captain Picard always stuck to his guns.

Not only was Star Trek a fascinating study in ethics, it was a fascinating study in missions philosophy.  The prime directive in essence prohibited Starfleet personnel from interfering with the internal development of alien civilizations.  A less developed world should be handled very carefully.  The indigenous leadership had to be respected.  The local laws had to be followed, even if they didn’t seem to make sense.  The crew of the Enterprise was proactive in trying to understand a new world (they even had a shrink aboard), and they were careful not to interfere with local matters without great need and only in the context of true cultural understanding and awareness.

Commonly, the plot involved Captain Picard and his crew visiting a new and less developed world, where they had to be very careful not to put technology into the hands of indigenous people who were not ready for it—who did not have the foundation to truly understand it.  Not just understand the physical laws of science upon which it was based.  More importantly, they needed to have the philosophical understanding of when to use it, and how and when to limit its use.  If the star voyagers didn’t hold to this directive, they invariably found that when they returned to that world in later years, there were big problems.  Amongst the people to whom the technological wonder had been given, the new power over the natural world had elevated them above their neighbors.  First they looked down on their neighbors.  Then they despised them.  Then they enslaved them.

A remarkably similar drama played itself out in the history of Africa (if you will allow me to oversimplify.)  A tribe was given guns by European or Arab slave traders.  They immediately became more powerful than the tribes around them, with whom they had been warring for generations.  Before long, they were capturing and selling their neighbors to the slavers.  It is STILL happening!  If a man believes it is normal, natural, and permissible to overpower and sell people who are not from his own tribe, when you give him any gift that makes him more powerful, he is going to continue to enslave his neighbors—and he is going to be more effective at it.  Obviously guns do that.  But so can education.  Learning to read and do arithmetic make you better at business, no matter how diabolical your business may be.

The story African history and Star Trek both tell is, it is very dangerous to hand people a technology that they don’t have a foundation for.  This happened with guns in 18th and 19th century Africa, and it’s still happening in Somalia, Sudan, Congo, et cetera.  And, it’s happening with guns in America.  When America was chivalrous, guns in the hands of the people were not nearly so dangerous as they are becoming now.  When we shared and valued a common foundational belief that not only is it wrong for a person with much power to take advantage of a person with less power, but it is actually the responsibility of the person with power to take care of the person with less power (my definition of chivalry), then guns were not so dangerous because our cultural assumptions limited their use.  But I don’t think we assume that anymore.  Western culture has devolved into a power grab.  Guns are a very useful bit of technology in that contest: anyone who grabs a gun gets instant power.

I’ve spend a decade working in maximum and super-maximum security prisons, so I know a thing or two about thugs.  The dangerous thing about thugs, be they Sudanese mercenaries, Somali warlords, or Chicago street gangsters, is not their guns.  Not primarily.  It’s how, and what, they think.  It’s their view of life, reality, and the world.

Observe the victim mindset of Job in Job 30:9-19, Job at his worst, most desperate, fatalistic, and hopeless, just before he finally says “the words of Job are ended:”

      Now they come and laugh at me;

      I am nothing but a joke to them.

      They treat me with disgust;

            They think they are too good for me.

         Because God has made me weak and helpless,

        They turn against me with all their fury.

      This mob attacks me head-on;

       They send me running; they prepare their final assault.

       They cut off my escape and try to destroy me;

    And there is no one to stop them.

      They pour through the holes in my defenses

     and come crashing down on top of me;

I am overcome with terror;

   My dignity is gone like a puff of wind,

   And my prosperity like a cloud.

Now I am about to die;

   There is no relief for my suffering.

At night my bones all ache;

   The pain that gnaws me never stops.

           God seizes me by the collar and twists my clothes out of shape.

He throws me down in the mud;

I am no better than dirt.
                                                    (Good News Translation)

Now take this worldview and put it in the mind of a man made desperate by circumstances: an African village in famine, the Atlanta slums with no jobs and racial discord, the Arabian desert amidst tribal warfare, or (dare I say?) an Asian American college student plagued by mental illness and loose on the Virginia Tech campus in 2007 (my home town).  These circumstances are common to man throughout history.

This is a man (any and all of them) who sees life as out of control, random, unjust, and malevolent.   He is fearful, purposeless, and worst of all hopeless.  He does not see his life, or anyone else’s life, as valuable.

Now put a gun in his hand.  No wonder he is dangerous!

He does not know:

            Help those who have less power than you.

            Do not be easily offended.

            Bear with one another in grace.

            Happy are the humble, merciful, pure in heart, persecuted, and peacemakers.

            Love thy neighbor.

            Love thy enemy!

He is dangerous because of how and what he thinks.

The gun is really just a bit of technology that magnifies the problem terribly.  It is not the root of the problem.  It is just a technological tool.

The difficulty for us in the West comes in because we, like Captain Picard, have a vast array of wondrous technological tools.  They must be wielded very, very carefully.  Medicine, wireless communications, sophisticated digital banking, etc.  If we put any of these tools into the hands of a person or people divorced from the Worldview that birthed (and constrains) the tool, we build a ticking time bomb.

You think the above (obviously good) technologies can’t be dangerous?  (Yes, I mean “good technologies.”  The idea that technology is morally neutral is a myth that only an American could believe.)  Then, what is the difference between guns in the hand of a tribal warlord, medicine in the hands of the Nazi doctors, an iPhone in the hands of a gang leader in prison, or high-tech finance in the hands of one of Ayn Rand’s more hardnosed characters?

And how does the desperate and fatalistic man see a gun or other bit of technology?  Accurately.  As power.  Power over the natural world.  Power over his neighbors.  Power to be grabbed.  He actually sees technology in much the same way that the animistic pagan in an African village sees witchcraft: as the power of the shaman to put a hex on any neighbor he is paid enough to curse.  If you believe like the desperate fatalist, then both a magic spell and an AK-47 are ill and ugly power tools.

The answer to the problem is not to limit access to technology.  That was the Star Trek answer, because the writers and producers dared not consider or publicize the true and scandalous answer.

The answer is to change how people think—cultural imperialism.  I think you know I don’t mean exporting Western culture.

Here we are, back at the Beatitudes again.  Talk about changing how people think.  Jesus turns the whole world on its head.

Beware the technological solution for a moral problem.

Technology as Magic

Written by Ty

If you have traveled much in Africa, you will have witnessed and wondered at: vehicles absurdly overloaded and driven with reckless abandon, churches with PA systems turned up way too loud, lights, TVs, and radios that seem to be on for no reason, as well as other strange uses of and attitudes toward technology.

In my last post, I tried to unpack the fascinating and convoluted issues surrounding technology in Africa.  A mentor of mine describes one of the major problems in Africa as “technology without science.”  By science he means the foundational philosophy that gives birth to technology, a way of finding out truths about the natural world—as opposed to the “scientism” or “empiricism” of the West, which at its root is a religious belief that science can explain everything—that the only kind of knowledge that can be trusted is knowledge that can be empirically proven—as if this were the ONLY legitimate kind of knowing.

The African villager, who generally has animistic pagan worldview assumptions whether he calls himself a Christian or not, typically views technology in much the same way as he views witchcraft. To him, both technology and sorcery are useful tools for exercising power over the natural world—your environment, circumstances, and other people.  At its end, technology is an exercise in power.  It can allow you to do magical things that any practical person would find useful, such as: have light at night, scare away intruders, carry your voice over large distances, travel two days walk in one hour, and even talk to people in distant villages.  And it is assumed if you have any of these kinds of power, you should use it.  A side note: Interestingly and more than a little frighteningly, Oppenheimer, the leader of the Manhattan Project, believed much the same thing.  “Why build the bomb?” he was asked.  He replied, “Because we can.”

My last post explored an example of “technology without science.”  Let me trot out a few more examples:

Electronics.  These are the most commonly witnessed example of technology as magic.  You almost never see a television that is turned off.   I even sometimes see them intentionally left on, with the volume turned way up, all night long.  If you see a TV that is turned off during waking hours, it is safe to assume that the power is out.  I recently had a fairly important meeting with a high up government official—one of the top 200 men in the country.  We met in his office.  The TV was on when we entered the room (though he was ignoring it).  It remained on during the entire meeting.  I was not nearly so able to ignore it as he was—it was showing some sleazy South American soap opera.  It remained on when we left.  It seemed so bizarre to me that this good, reputable, and powerful man would tolerate this appliance being intrusive all the time, but he did.  Remember, the thinking is: if you have the power, use it.

About a year ago, I was kept up almost all night by a very loud recording of some kind that our neighbor played all night long.  It was massively distorted and SUPER loud—way louder than a TV could ever be on it’s own.  Believe me, the cops would show up if you did this in America.  Though it was in Swahili, after several hours of it I eventually figured out that this too was another seedy soap opera.  This one, I think, was Nigerian in origin, overdubbed in Swahili.  By 3 AM, I had had all I could take.  I got dressed and into the blackness of the village.  I was going to insist that somebody turn that commotion off.  I was mad.  As I stormed through the front gate of the City of Hope, one of the security guards, surprised to see me at 3AM, asked if there was a medical emergency.

“What is that NOISE?  Why are they doing that?” I bemoaned, pointing to the neighbor’s house a few hundred yards off.

“Oh that,” he said.  “That’s just the youth.”

“The youth?”

“Yes... Having a rally.”

I just stood there dumbfounded, not even knowing what to ask.  “Why are they making that noise so loud?” I asked after a while.  (Yes, my Swahili sounds like a three year old.)

“Don’t worry.  It’s nothing bad,” he assured me.  “People like it.  The neighbors like it.  It’s not a problem.”

I wanted to ask, “What do you mean they like it?  They LIKE people blaring that trash to the whole neighborhood all night long?”  But I didn’t ask.  It was already clear that the answer was yes.  Now I know that people think, “If you have the power, use it.”

I gave up and tried to go back to sleep.  Mercifully, the car battery they were using for power ran out of juice about half an hour later.

P. A. systems are used in the much the same way.  Africans can sing beautifully in wonderful and multilayered harmonies.  And dance.  They just seem to be born with it.  There is great potential for aesthetically beautiful church services.  Fifty years ago, it must have been that way.  Enter, technology.  Now, any church that can possibly afford them has a PA system, a keyboard, and a microphone.  I’m talking about churches with dirt floors, mud walls, and thatch roofs that seat fifty people on rickety benches.  They have these things, more often than not.  Usually they don’t have anyone who can actually play the keyboard.  So the entire service, every one of the twenty or so songs, is sung to some variation of the keyboard’s “demo” mode,--the composition of some nameless Casio employee.  The demo mode is certainly the most important option to have on your church keyboard out in the bush.  And again, the room is no bigger than a large living room in America.  You don’t need a PA system.  But not only is there almost always one present, it is ALWAYS turned all the way up, so is therefore insanely distorted.  It’s hard enough to follow a sermon in a second language when it’s not distorted.  Furthermore, I have been approached many times and asked to donate some money to such and such church—they are having a fundraiser.  Guess what for?  Every single time, it has been for a keyboard and PA system.  I grieve over this.  I like our little church here with 200 children and no technology.  Two weeks ago one of our sixteen year olds preached.  I was so proud of him.

Phones.  I find mobile phones irritating enough in America, but it’s even worse here.   I used to find it strange that here, in a very very relational culture, if your phone rings, you interrupt whatever conversation you are having, and you answer it, pretty much no matter who you are talking to in person.  No apologies are made or expected.  A while ago I explained to a teacher that in America this behavior would be considered quite rude.  His disbelieving response was, “But it’s the phone!” At the time, I couldn’t make much sense out of his rejoinder.  Since then I have realized that even my fairly educated friend (for the village) thinks of his phone more as a talisman of magical power than as a tool.  Last week I sat in a “restaurant” having tea while our truck was being loaded with sheet metal.  A lone young man across from me was making a very public display of his power and success.  He had four cell phones arrayed on the table in front of him in a little arc, and for at least half an hour made a show of fiddling with each contraption in turn.  He didn’t even make any calls. He just toyed with them.  For show.  I kinda wanted to chuck them into the open sewer nearby.

As a segue to my bit on vehicles, I’ll tell you something fantastic that I just saw two days ago.  I kid you not, I saw a young guy riding a motorcycle on a very rough dirt road and texting at the same time!  He was not a passenger.  He was driving.  I hope he is still alive.

Vehicles.  Now this example, though it really is seriously dangerous, I still usually find kind of funny. The same day I saw the motorcycle texter, I saw the second most ridiculous load on a motorcycle I have ever seen: a coffin.  I don’t know whether it was occupied or not, though I suspect that it was, because there was only one other person on the bike—the driver.  If the coffin had been empty, there would have been at least one more passenger along for the ride—why waste the power?  (The most ridiculous thing I have ever seen tied to the back of a motorcycle was a 55-gallon drum—full of gasoline! That’s basically a bomb on wheels.  He should make an arrangement with the guy with the coffin.)  These examples are to show that the general philosophy of motor vehicle traffic here is: drive as fast as you possibly can at all times, while carrying the largest possible load that you can—to the point of absurdity.  This behavior is now beginning to make more sense to me.  It’s not just about trying to get the best economy out of our vehicle as you can, because overloading your vehicle will certainly break it and cost more money in the long run.  The philosophy is, “Get absolutely as much power out of your magic carpet (vehicle) as you possibly can at all times. Take advantage of this power now, while it is available to you, because the magic in the carpet may no longer work later.” This also explains much about the condition of both the roads and the vehicles.  If you believe that science is the foundation for the working of your car, then you maintain it.  If you believe that magic makes your car go and that evil spirits make it stop, then you don’t maintain it.  I once heard a Canadian in Africa proclaim in jest, “Everyone knows oil is just an American hang up!”  Also noteworthy: I am told that in the capital city, if two identical cars are for sale, and one was owned by a mzungu while the other was owned by a Tanzanian, the foreigner’s car will bring twice as much money.

A small confession.  Sometimes I don't blame people for thinking of cars a magic.  I once stayed in Kenyan mountain village for a few months, which could only be accessed by an unbelievably bad "road."  Many times it was all one could do to get a very capable Land Cruiser up that road.  But one day I walked out of the clinic to find a Toyota Corolla parked in the village.  "How did they ever get that thing up here?" I wondered.  It did seem that that Corolla had super powers!

Education.  This one really irks me.  Most schools have a motto painted on some public space, often a sign on the road.  Usually this motto reads, “Knowledge is power,” or “Education is wealth,” or some variation thereof.  The worst one I ever saw read: "Education is a weapon." Yuck. The focus on power is clear.  I might ask, “Power to do what?” or, “Wealth which will accomplish what?”  Unmitigated power is not necessarily a good thing.  As I have said before, if you increase an evil man’s power by educating him, you are just going to make him more effective at doing evil.  While I agree that knowledge and education tend to lead to power and wealth, this ought not be the prime motivation for seeking knowledge.  Compare this power grab understanding of education with the words of St. Augustine, “Credo ut intelligam.”  Loosely translated, “I believe in order to understand.”  I am all for African kids getting educated.  In fact I am spending a significant part of my life and resources to exactly that end.  But education should be the pursuit of truth.  Not the pursuit of power.

Medicine.  This should be the area where I have the most insight.  But I don’t.  I’m still working through it.  I can think of a few simple examples.

We had an earthquake about two weeks ago.  It was at about 9PM.  I was asleep.  I woke up thinking, "Why does it sound like there is a bus on the roof?"  But it wasn't a big earthquake.  Nothing was broken.  For the last two weeks, we have be assailed by a flu epidemic of some kind.  Nearly everyone has developed fever, headaches, and GI symptoms.  Someone just told me this morning that it is well known that whenever there is an earthquake, many people will become sick.

Patients in the hospital frequently turn up the rate in their own intravenous drips.  Outpatients sometimes go home with ten days of antibiotics and take them all in one day.  If some medicine (magic potion) is good, then more is better, right?  Most patients at our clinic have been to a traditional healer or shaman before they come to the clinic.  Perhaps they come to ascertain whether we have more power than the shaman.  I have noticed a sharp increase in patient volume when there are white people present at the clinic, including me.  This is one of the reasons I actually limit my time at the clinic.  I want neither the Tanzanian staff nor the public to think that the clinic’s performance is dependent on me—or my power.  Some mission hospitals are introducing CAT scanners.  They charge less than ten percent of what the same study would cost in America.  You can fly to Nairobi, get a CAT scan, and fly back to America for about the same price as getting the same CAT scan in America.  But these are still expensive machines that have to be maintained with costly imported parts and foreign personnel.  So in this economy it still costs a princely sum to get a CAT scan—more than most people make in a month. Just think of what incredible magical powers these expensive contraptions from the West are imagined to have--perhaps even more than an earthquake!