Friday, February 28, 2014

Ideas Have Consequences

by David and Jana Villanueva
David and Jana V. are visiting students from VCOM (Virginia College of Osteopathic Medicine). David is a 4th year student receiving elective credit this month, Jana is entering PA school this summer. They are parents to 18 month old Blake.

Ideas have consequences. Our thoughts and beliefs about life form our “worldview”—or how we “see the world”—and our worldviews directly affect how we act. This is true in every culture. When Jesus came to earth, he came to bring in His Kingdom, his way of life. All of his teachings were counter-cultural, but not just to the Jews and the Gentiles of his day. His ways are counter-cultural for every culture in history because this world and every person who has ever been born into it are broken, body and soul. Jesus came to show us the way to wholeness, the truth to transform our minds, and the life we were created to enjoy. Being in a relationship with him changes us completely from the inside out.

Do you ever find yourself asking why you do what you do? I’m pretty analytical, so I do all the time, but never as much as I do when I’m in another culture. One of the primary reasons our family is here at City of Hope in Tanzania is to discuss with other believers what it means to join God’s work in bringing the Gospel to all nations, not just overseas in Africa, but in the United States as well.

There are many differences in how our family does life in Tanzania, compared to how we do life in Virginia. In America, I do my laundry in machines, enjoy hot showers and wear whatever I want. I live in a nice townhouse, use indoor plumbing and electricity, and enjoy the conveniences of stores like Wal-Mart and paved roads. Here in Africa, I wash my clothes and Blake’s diapers by hand, take showers from buckets, and wear long skirts. I avoid drinking any water that has not been filtered, live in a concrete room, sleep under mosquito nets, and it easily takes an entire day to go to the closest market to purchase food because the roads are dirty and bumpy and I speak very little Swahili. In America, I have novelties like my iPhone, computer, and Netflix. In Africa, we have dance parties with the children for entertainment and play with balls made out of socks. These are huge differences in thinking, but they are not the differences on which we as believers should focus our missional endeavors. I am grateful to live in America, and I enjoy all the technology and freedoms that come with it, but people who live here at City of Hope are happy. The children at the school don’t complain about walking half a mile to get water from a spring twice a day. The women here are not upset about spending their day cleaning, washing clothes by hand, and preparing food. No fretting over cold baths or not being able to wear pants. Why? Because Americans and Africans think differently in these categories. But really, these areas are not all that important. I don’t think God cares if I wash clothes in a machine or by hand or if I wear a long skirt or pants…

So, what determines what really matters, then? What does God care about? I want to share a story with you that Dr. Ty Hopkins, the medical director here, shared with our group. A year or so ago, a Tanzanian baby named Daudi was brought to the clinic by his grandmother for a wound on his foot that would not heal. The medical team was quick to diagnose the baby with malnutrition and prescribed an easy recipe for a milk, oil, and sugar concoction that would restore the baby’s health. But over time, the baby did not improve or gain weight. The team soon realized that the grandmother was not giving the baby the prescribed nutrition, even though they provided the grandmother with all the help and materials she needed. Eventually, volunteer American nurses decided to care for and feed the baby themselves until he finally got well. Ty asked us, “Why? Why did the grandmother, who truly did love her grandson, choose not to follow the doctor’s orders despite all the help and supplies given to her? Why did the baby thrive when cared for by young American girls who had never been moms and not with the baby’s own family?”

The issue is ideas have consequences. The prevalent worldview here is animism. A major aspect of this worldview is fatalism. Everything is controlled by spirits, therefore, fear drives most decision-making. Time is cyclic (wet and dry seasons, harvests), so there is very little emphasis on progress. Power is considered the highest of virtues in society, so morality is relative as the most powerful makes the rules. Life has little value, and “god” is a fluid concept even in many areas that have heard the Gospel. Christianity is mixed in with animistic beliefs involving ancestral spirits, shamans, and curses.

People in every culture and time in history have always struggled with the lies that come with a fatalistic thinking, including Americans. But we westerners also struggle with a different conglomeration of unbiblical ideas: materialism, naturalism, and hedonism. The prosperity gospel has contaminated our churches, falsely teaching us that we are in control of our lives, and we can manipulate God into blessing us by striving to do good works. Following suit with the American Dream mentality, we incorrectly define blessings as whatever we think will make us the happiest (see the Sermon on the Mount in Matthew 5 for God’s version). Americans see time as linear, so progress is idolized. All of our efforts are poured into advances in technology and education to stay in control and to avoid suffering and death. Truth is relative in our culture too, as what is right is determined by the majority. In our nation, a person’s level of usefulness in society is the determining factor for whether or not their life is valuable. Abortion is the leading cause of death in our country and the elderly are marginalized rather than shown respect. In America, we often curse God the moment we lose someone or something dear to us while most Africans have lost at least one family member to a preventable cause—like water-borne illness, malaria, HIV, malnutrition, or tribal warfare. Death, pain and loss are not ideas of which you must convince an African. But in our American bubbles of comfort, technology and ease, sometimes it’s hard to accept that everything about us and this world is broken. But it is. The point is, our culture in America is just as broken and in need of a Savior as the culture is here.

I wanted to write this entry to make you think, just as I’ve been thinking, about what it means to be a missionary. Many people asked me before I left for Africa what I’d be doing here, but honestly, I didn’t know what to say. Our family came here to do a little medicine, yes, but mostly, we came to hear from God, to see what he is already doing here in Tanzania for his name’s sake, and to ask him if he’d like us to join that work at some point in our future. We want to share the Gospel and serve the medically underserved, but whether it’s here in Africa or at home in the states is still a mystery. We are learning that one is not superior to the other. Much of spiritual warfare is a battle for the mind, and the need for true, Christ-centered community and Spirit-empowered transformation of individuals, families, and cultures is universal. The important thing is to let Jesus’s Kingdom reign—in your life, in my life—wherever we are, and slowly but surely, his light will conquer the darkness one community at a time.

So why serve overseas at all? Why not just serve in America? Why do Ty and Joi bring their three young children to Tanzania half of the year to serve the Lord here as a family? I want to end this entry by telling you that the baby Dr. Ty told the story about died from malaria only three months after getting well. He and millions of others die of diseases that could be prevented if only this culture was transformed by a biblical worldview. So what is the biblical worldview?

The Bible tells us that God is sovereign over all, but he does give humans the mandate to exercise some of his rule on earth. God reveals who he is in Scripture. God is loving and good, and He gives us purpose. He has a plan for our lives, which all has to do with knowing him and making him known to others. Life is sacred because we are made in his image. Our hope is in eternity, not in this world, but he calls and enables us to join him in bringing his Kingdom to earth in this present age (“thy will be done, on earth as it is in heaven”). Morality is not “majority rules” or “might makes right;” instead, God defines what is good and right by his own character, which he has revealed to us in his Law. When a person joins God’s Kingdom through faith in Christ, the Spirit of God comes to live inside that person, and he provides a new heart that desires to display God’s character and a mind that thinks as God does (we are given the mind of Christ). Our destiny is to live forever with God in perfect community with all his people in a heaven and earth that is free from sin, death, and suffering (see the book of Revelation, chapter 21). So even though we groan and mourn the sufferings of this world, we do not grieve without hope. And we spend our talents and our energy loving God with our mind, soul, and body until our time here comes to a close. In Christ, there is no fear of death, for when we die, we cross from death to life to be with Jesus.

Instead of Daudi’s grandmother thinking that sickness is caused by shamans, evil spirits, or a distant and angry God, she could be empowered by the Spirit to believe the truth—that God is loving, good and in control, and that he ordains some control to us to take care of the bodies he has given us. Because God is knowable, one way he has enabled us to get to know him is by studying the things he has wonderfully made, like our physical bodies. He designed our bodies to build, repair and fight infection, and we act as image-bearers of God when we give our bodies the materials they need with proper nutrition. Knowing that life is sacred, Daudi’s grandmother would be motivated to feed her grandchild so he could grow strong instead of feeling as if there is no hope.

So doing mission work in Africa is not exactly what you might imagine. I know it’s not what I once imagined. Malaria, HIV, malnutrition—westerners have provided the resources and education necessary for Africans to deal with these issues, but without a worldview change, there will not be results. How do you help an African understand that Malaria is a disease caused by parasites carried by mosquitoes, not a curse put on people by angry relatives or competing tribes? This must be accomplished before Africans will utilize mosquito nets and install window screens. As for malnutrition, the solution is not bringing food over to a continent that is starving from a lack of resources. This continent is full of resources, yet people are still starving. There has to be a mindset change. Lowering HIV rates is not as simple as just bringing over more HIV medications. We have to communicate the causes of HIV in a way that actually changes things. How do we join the Spirit’s work in bringing God’s Kingdom mindset to our brothers and sisters in Africa? These are the big questions we are asking God and each other.

Ideas have consequences. False ones destroy from the inside out, but believing true ideas—learning to see time, relationships, family, work, health, and poverty as God does—that leads to living life as we were made to live it; it’s bringing the Kingdom of Heaven to Earth. And that is mission work that echoes for eternity. That’s the kind I want to be a part of, wherever I am. We can help each other. The African who struggles with animistic thinking understands the godly importance of prioritizing relationships over projects and procedures, while most Americans can learn to slow down and take time to really be with one another. And as the American learns from the African, the African can learn from an American that God does give us some control in this life as image-bearers and rulers over his creation. Both cultures need to be transformed by God and His Word. It’s His Word that matters, not the traditions of men.

Ideas have consequences. So why do you do what you do? Think about it, as I continue to do the same.

Wednesday, February 26, 2014

Sad Stories

By Ty

We had a baby boy born at the hospital last night. Thankfully, he and his mother are physically quite well. He is 8.5 pounds, which is absolutely enormous for here. She is 17 and physically strong. But her social and spiritual situation is awful. She is the oldest of 10 kids. Her dad ran around and brought HIV home to his wife. He died a year ago. Until he got sick, he had a job, and a few of his kids (boys) were sent to our school here (the local people can send their kids for a small fee). After the father died, the mother came and told us that she couldn't pay anymore. Two boys who wanted to stay here now live in our children's home under sponsorship. Then the mother died, also of AIDS, about three months ago. This 17 year old girl was then also was accepted into the children's home. But a couple of days later, during routine medical screening, we discovered she was pregnant. No one knows who the father is. We just don't have a way to keep a girl with a baby in the children's home. It's a different category and level of care. How can she go to school with a baby? Where can the baby sleep? etc. etc. A job was found for her in the village, basically as a nanny for a man whose wife ran away and left him with 3 small children. He actually seems to be pretty good to her. He sent his sister to be with her at the birth, and even came from his job far away when he heard the baby was coming, which is more than many husbands do. None of her relatives came to support her during the birth. It's sad how adultery is just seen as "normal" here, but if a woman has a baby out of wedlock, she is an outcast.

She's in a pretty desperate state. She was absolutely terrified during the labor and delivery. Joi and an American PA student, Jana, were there with her. She insisted on leaving the hospital only an hour after she gave birth. She had a tear that she refused to allow the nurse to suture. She doesn't have a clue how to feed and take care of the baby. She seems afraid to even touch him. She is going to need a lot of encouragement and teaching and TLC. Obviously, her employer, though a good guy, is a 25-year-old man with a job and he isn't equipped to give her all the help she needs. Joi and Jana are going to see her at her house today. And they will go regularly. We are considering offering her a job here at City of Hope, so that she can be near her little brothers—good for her and good for them. This is going to be an uphill battle. Many babies in this situation die.

We had another similar case in January. She was a 16-year-old prostitute, also an orphan. Her baby died when he was ten days old. Then the villagers (where she was living in a village about an hour's drive away) proceeded to march her around the village and flog her—literally. And call her murderer. She wasn't, she was just sick, with no one helping her, and she didn't know how to take care of her baby. Then they threw her in jail. That’s when we found out about it. By the time we found her in jail, she had been there 2 or 3 days and was septic and on the verge of death from a uterine infection. Her family told us to leave her alone and let her die because she had brought them shame. She almost did die. The nursing staff put her on IV antibiotics and nursed her back to health. She was then given a job here. But after a few weeks she wanted to leave again. I hear she's back with her grandmother now and doing OK. But unfortunately she's likely to slide back into prostitution. She also seems to have some mental health issues, based on some things I am told that she was saying, though she never really talked directly to me. She just smiled and acted like everything was fine.

In both of these situations, it's hard to even know where to start. And this kind of stuff is totally common. These girls need much more than technological medical care. At this point they are actually both physically pretty healthy. Even a gospel presentation is not enough. They need the gospel lived out in their midst. I must admit, that's easier said than done.

I tell you this to give you an idea of what kinds of things we are up against here. We have to be preaching the gospel, making disciples, and changing the culture if we are ever going to make a dent in all the suffering. Bringing up a whole generation of kids steeped in the gospel in the children's home will hopefully make a difference. We can already see that they are learning to think and act differently from the community. But most days, this whole thing seems like one enormous uphill battle.

Please note, though I use the pronouns “we” and “our” above, I deserve little to no credit for helping these girls with anything beyond their physical needs. The local Tanzanian Christian leaders with whom we work did all that. I use the words “we” and “our” out of a spirit of cooperation and unity. But don’t give me any credit. I’m not the one who went and rescued that girl from certain death in jail. I am very proud to be associated with the men who did.

Please pray for these girls. Imagine if your daughter or sister was in this kind of situation. I really can’t bear to imagine it. They really need hope. We try to help them discover real hope in the immeasurable restorative power of Christ. Still, you can see why there are challenges.

Wednesday, February 19, 2014

A conversation with a medical student about the natures of health, mission, and career

By Ty

The following is an actual conversation between a medical student and me.  His comments and questions are in black.  Mine are blue.

Thanks for such a thoughtful response. I have been pondering the questions you have posed this whole weekend, and most certainly have not come to any satisfying answers.

Don't be too hard on yourself.  It took me years to start to make some sense out of these things.  But good for you for being honest about it.  The first hurdle to get over (and you already have) is realizing that you don't have all the answers, and having the humility to seek honestly.  I find that many students are really not intellectually honest--they assume that their education (id est, ideology) has all the answers, or perhaps they intuitively fear that it doesn't, so they are afraid to engage.  Actually I think your answers below are a pretty good start.  You are way ahead of where I was as a 3rd year medical student!

The blog post I first read was “A Confession.” The honesty with which you write resonated with me. Also when you talked about "the small amount of curative care" you are providing at the clinic and also struck a cord with me as well. It seemed to me you were implying there must be more work to be done, in not just providing primary care but also in teaching and change the way people thought and lived. I went on a short term medical mission trip during undergrad and remember upon coming home thinking home we helped cure people, gave them pills and such, but that they would just get sick again. What we did was good, it helped relieve suffering, but it wasn't the end all be all. And at the same time you pointed out, the answer is also not bringing Western medicine and training. Our purpose is greater still. It may be more difficult and not as popular, but it is true and I like that.

You are right about much of this.  Most students don't have the insight to realize that the small amount of curative care, while a good thing, is far from complete.  I think this is often because students usually are still pretty enamored with the technology of medicine (which is in fact impressive).  But usually this idolatry has started to change around the time of internship.  Then they become cynics (disappointed idealists), which is perhaps worse than idolatrous idealism, because it’s still idolatry, but a lower idol.  Older docs tend to more easily see the relative ineffectiveness (and even possible--nay usual--harm) of the short term curative care mission trips.  They are fine to do, but must be done very carefully and in genuine partnership with the local church—way more easily said than done.
Much, much more is possible--and necessary if we are to join Christ in building His kingdom.  Certainly He doesn't want Africa to become a Welfare Continent, or Africans to be beggars--dependent upon and beholden to Western good will and deprived of the dignity of being able to improve their own lives.  But if these next steps are not taken, that is what our missions will tend toward.

Yesterday someone asked me what specialty to choose if you want to be a missionary.  You're thinking about that too.  The last 100 years in Africa missionaries have been doers in health care in Africa--and most of those people are heroes.  But Africa has changed, and we are now in a different phase of building his kingdom.  For the next 100 years, most appropriately, medical missionaries will be educators.  That is the future and I think it's what God is doing here now.  If you are going to be a doer, then it makes sense to do FP, because you have to do a bit of everything out here.  Most of what we do is children and OB, with lots of other things thrown in.  Maybe 30% pediatrics, 30% OB, and 40% everything else.  FP training is the next wave of improvement in medical services for the next 20-40 years in Africa because it will get basic primary care to the villages.  There are many hundreds of African doctors being trained right now, and that is growing fast.  The next step will be to develop residency training for them.  First it will be FP residencies, and other primary care residencies.  There are dozens of FP residencies in Africa right now.  Within 10 years I believe there will be 100 or more.  Of course it makes sense to start teaching specialties too—soon—even now in some places.  So, within 10 years, it will be appropriate to be any specialty as long as you are willing to be a teacher primarily.  That's already what I'm doing.  I'm teaching much more than I'm doing.

So to your question of what is health? I spent a lot of time thinking about this and still am. I can see how you could spend a month simply talking through this one question. I started with health is the lack of any medical pathology.

That is in fact the party line that is taught in almost every university--either tacitly or overtly.  Any clever philosophy student, I think, would see that it is inadequate right away.  However that exact definition comes out of the mouths of people at every level of the institution, and strangely hardly goes challenged at all.  Worse yet, the subject doesn't really even come up!  We just go about our business with catheters, scalpels, and chemicals, and don't even really think about what ultimate goal we are actually aiming at.  This deficiency of big picture understanding and purpose is a major source of the cynicism mentioned above.  The cynicism, while wrong, and destructive, is hard to be judgmental of: Who doesn't get tired of admitting the same chronic (alcoholic, obese, depressed, or fill in the blank here) patient to the floor over and over again, and going through the same technological motions over and over again, knowing that they are inadequate tools for the problem and thus won't work?  You have seen the residents admit many of these cases to the floors by now--it's probably half the patients.  Do the residents act like they think that what they are doing is going to at some point start to work and eventually deliver this person to health?  They know (intuitively, even if not consciously) that it won't work.  That's why they act the way they do.  But they don't know what else to do because they have been given no cohesive philosophical foundation for what health is.  They have just been told, "Health is the absence of disease."  By “disease” they mean bio-psycho-chemical-mechanical disorder.  But you and I know there is more to a human person than that.  The cynical residents know it too.

That seemed like a good medical school answer. But that wasn't satisfying for at least two reasons. First, that would mean no one is truly healthy since we all deviate from the norm in some way. Second, physical health is not the only determinate of health; there are many more aspects that go into one's health. 

Right, as above.

Then I though maybe a functional definition of health is better. Therefore health is simply being able to do the things one wants to do (that are within reason for a normal human) without undue interference from their body or mind. But that answer was a little too relativistic for my liking.  Health would then be different for everyone and I don't know if that is true either. Maybe someone wants to just sit on the couch and watch TV all day, so having heart failure doesn't really bother them. There most be a level of objectivity to it.

Agreed, totally relativistic--like I said, you are way ahead to realize this.  This functional definition is also typically given in the university setting.  I hear this one from students all the time too.  Your example is apt.  People can't just invent for themselves what they think health is.  There is TRUTH about what is good for you and what is not.  You can't even practice science (and try to apply it to health) if you don't believe that.  What would you say to the patient who says: "Look doc, you may think your science proves that smoking is bad, but I don't believe it's bad for me."?  It doesn't work.  You have to believe that what you tell patients is true.  And furthermore, much of what you do is tell patients what they OUGHT to do--this is inherently a moral exercise and is dependent on a belief in truth.  If you don't believe in truth, how could you possible tell a patient what they OUGHT to do?  And of course patients do want us to tell them what they ought to do.  That is why there are there.  And they want it to be true.

Furthermore, if you take this definition outside of our culture, it falls apart immediately, (and in fact falls apart in many or most contexts within our culture.)  How would it work when two different people's opinions about what they "want to do" collide?  This is inevitable.  Some people think aborting babies is bad for the health.  Others try to argue that it is good.  I am sitting in a village right now, where most people would tell me that it is "healthy" and "good" to take 12 year old girls and mutilate their genitals, by force, cutting off most of the labia majora, and sometimes labia minora and/or clitoris.  They say that makes the girls better at being wives and bearing children and that you can’t get married without it.  This is a common belief with many tribes in Africa.  On what basis may I tell them that this is not true and this practice is destructive and unhealthy?  I must believe in absolute truth to do that.  I must believe that my definition of health is right and theirs is wrong.  They are wrong even though they are in the great majority here (Mob rule doesn't make anything right).  And I must be willing to tell them what they OUGHT to do based on that Truth in which I believe.  It's either that or I just accept that pinning little girls down and cutting them with an unwashed kitchen knife is healthy.

I didn't get much further than that, except to realize that how one conceives of health is shaped by everything, your worldview, experiences, etc. My idea of what a healthy life is as a Christian may be much different than a person in Europe. Whether those conceptions of health are both true and accurate is question I don't know the answer to. It seems there is some level of relativity to health, but a good dose of objectivity as well. I would love to hear your thoughts on the matter, or seeing as that might be a month's worth of discussion, your thoughts on my thinking.

Yes, Worldview is central.  And at the root of Worldview are the questions of what you believe about the transcendent.  Who is God?  Who is Man?  What does it mean to be a human person?  What is a good human person?  You can see how and why I spend a month on this stuff--and I try to do it during foundational years.

And to define career. That was also a tricky question. I've always just thought I thought about it as what I do to make money. But when I began to think about what it really meant to me, I realized it is not just money, but how I hope to gain significance in life. And when I pose the question to myself in that way, I realize the foolishness of trying to use my job or trained skill to gain significance in this life. 

Right.  Medicine is really just a tool.  Idolizing it like idolizing a wrench.  Now it's a fantastically useful tool.  But it can't give your life meaning.  Again, think of the cynical residents.  They are cynical because they are realizing this fact--usually on an unconscious, or at least unspoken level.

I am significant because I am a child of God, known by Him, and any earthly significance I seek out pales in comparison. 

Amen.  Career is not a bad thing.  But it's not a first thing.  To adapt a witticism from C.S. Lewis:  Aim at heaven (Christ, the first thing) and you will get everything else thrown in--including a career.  Aim at a career, and you will get neither.

So now I don't really know what to think, other than I probably shouldn't think of my life as being defined by my career, at least in terms of how the world views my progression as a doctor and growing in standing among my peers. My big question has always been knowing that my career is not where I will ultimately find my significance, how to I conceive of my work and how do I go about my training? To illustrate, early on during medical school I was torn about how much to study. On one hand I want to do things with excellence and honor God with my work, but I realized that "good" soon started to conflict with honoring my marriage and loving my wife. I resolved that by not pursuing the highest marks but trying to learn what I could well, but not worrying myself with being the best or trying to get AOA or whatever else awards. But I am starting to realize that conflict will always arise. How do I honor my patients and give them my best when that might conflict with my family? I don't know if you have any good answers, but just questions I have when I think about the idea of a career. 

You are right about these conflicts.  Career falls pretty far down on the list of God's priorities for us.  This is one of the reasons we need to have a biblical understanding of health as a cohesive philosophical foundation for the practice of medicine.  The Bible actually makes it quite clear that the order of priorities goes like this:
1.         God
2.         Your spouse
3.         Your kids
4.         Your calling, including, school, career, and ministry.  
5.         Earning a living; for many Americans and basically all doctors, this necessity can be subordinated to #4.

Put any of these things higher on the list than it deserves, and you will lose everything on the list that you have put under it--and you likely won't get the thing that you have wrongly over prioritized either.  Good for you that you didn't put school above your wife and in the end lose her.  I have seen that happen to way too many Christian students in medical school.  When you are 80 you are going to still want to have God, wife, and kids.  You won't care a whit for medicine or career.

How often are you in Tanzania? My original thought concerning coming to Tanzania was possibly next Spring. I have a very strong desire to be able to go with my wife, I want to learn and serve alongside her. Unfortunately her job is not very lenient with time off so we would probably need a good bit of foreknowledge if we wanted to be able to go together. 

We are here usually twice a year.  A few months in the summer and few months in the winter.  The summer is so that we can do the summer seminar I have been talking about, which is usually with about 15 students.  In the winter we take 3rd and 4th year medical students as well as residents for rotations, during which time we do this stuff too, but they also do a fair amount of clinical work in our clinic--usually because their school wants them to in order to get credit.  You will be most welcome to come next Jan-March.  Come for 2 rotations if you can!  And I applaud you for wanting to bring your wife.  We are fully supportive of that.  In fact in an hour I'm driving into town to pick up a medical student, his wife, and their 18-month-old son.  We are not just family friendly, we are family promotional.

Thank you again for your response and I look forward to continuing our conversation. Your letter was greatly refreshing to my soul and stirred things in my heart that had been left unprovoked for far too long. 

Like I said, after what you've been through, you need "a good brainwashing."  See Romans 12:1 and 1 Peter 4:1, both about our minds being transformed into the likeness of Jesus.

While I'm thinking of it, given that I’ve spent an hour or more on this, what do you think if I post the conversation above on our blog?  The reason for my request is: as you know, you are not the only person that needs to have this conversation.  Someone else out there might be blessed by it.

Monday, February 17, 2014

"Happy Birthday Big Brother!"

January 31st we enjoyed celebrating little T's 6th birthday together! We are so proud of the amazing little boy God has given us to care for while we are on this earth. His 6th year is already proving to be one of much growth and learning. little T is a gentle, sensitive soul. Since the arrival of the Villanueva family, t. has shown that he is truly gentle. The working definition of gentle that we use in our house is "strength under control". This is most evident when t and little Blake (18 months) "wrestle". I am amazed by the instinctive carefulness t. shows at just the right moments. I know he learned that from wrestling his dad! He also continues to be a very caring older brother to baby Ps., always concerned for his well-being and safety. He also loves learning, especially science, math and history. He is learning to read and especially loves to be read to. In the past 2 weeks he lost his first TWO teeth and does not enjoy pretending that there is a tooth fairy. ("Gramma, I know it was you.") Happy 6h Birthday little t. We are so glad to have you in this family!!

Wouldn't you love to hang your birthday balloons from banana trees??

Once again, a train cake was requested. I managed to convince t. to settle for a train station instead. Nancy made the chocolate cake and it was amazing.

t. LOVES the newfound freedom that has come with competent biking skills. He and Big T often ride up to the clinic and back together. No easy ride, especially since it's all uphill on the way there. Not to mention the necessary dodging of chickens, piki pikis (motorcycles), small children, goats and others on bicycles!

Sunday, February 16, 2014

Danner Update

written by our guests, Dr. Dee and Janet, who are here for about a month providing dental training, dishwashing services and comic relief. (See photo of Dee)

Habari Gani?  ("Hello how are you?" in KiSwahili) or Jambo!

The proper response is: Safi (Safee) which means "clean".

 So we find ourselves in Tanzania! We left our home on a Wednesday Jan. 29 at 9:30 am and arrived at City of Hope on Friday at 7:30pm.  Where did we lose a day? We did spend one night in a guest house in Nairobi, Kenya; however, we arrived there at 1 am and left at 5:30 am. We have heard the guest house is a beautiful place, however it was dark when we arrived and dark when we left!

Entrance to City of Hope
You can imagine on the 10 hour bus ride, I began to wonder why I was doing this. Talk about being tired! We had been told which town the bus stops in to get off and purchase some lunch, however we never knew which town we were in, so we missed lunch! The good news is that I had purchased two bags of Chex snacks at an airport, so we had that and water. This is a tea drinking country, luckily I had brought instant coffee that had cream and sugar already in it.  Wow, did that taste good in the morning!

Someone was to meet us at the end of the bus trip, and we knew the name of the town. Apparently the bus driver was picking up extra passengers and dropping them off where they wanted, so every time the bus stopped, we asked another passenger,is this the right town? I was a little anxious because this was the first time Dee and I had traveled alone. We had one problem after another and could not get our phone to work, so we had no way to contact anyone if something didn't go as planned.

Well everything did go as planned, we met our gracious host at the last bus stop, did the necessary paperwork to cross the border from Kenya into Tanzania and we were on the last leg of the trip to the City of Hope; dead tired. It was dark, the roads were dirt with potholes everywhere. People walking,kids playing, and motorbikes flying past, and our driver also going very fast! I think they could hear us coming and everyone flew out of our path! The most I would have gone was about 10mph on that road! So here we are flying through the country and all of a sudden he turns left and it was like another world. Beautiful flower pots, flowers everywhere and a beautiful painted gate with a roof over it! We passed through the gate and there were 100 children standing there singing to us that they were glad we were there and they were happy to see us! I can't explain to you the feeling of joy, peace and happiness that instantly came over me! It just couldn't have been any better, then all the children came to us wanting to tell us their names and shake hands. It just couldn't have been any better!

Banana Grove 
Walking to the Clinic.
We waited until Monday to start our class on dentistry. We have three women and two men and they all seem to be brillant. They learn very quickly. I have finished teaching them how to do fillings, now we just need patients for them to practice on. As soon as they have had some experience with fillings, Dee will begin teaching extractions.

One student was pregnant. I think it was on Thursday they said she could not come, she had some pain. She had her baby that night and told Dee she would be  back to our class on Monday! Can you imagine? She had her baby and 20 minutes later was on her way home!

The food has been great,except for the rocks in the rice. And if there is going to be one rock, it will always be in my rice!They are so small, you can't see them to pick them out.

If you ever have trouble waking up, take a cold shower in the morning as we are doing. Guarunteed, you will be awake, instantly!  Glad I brought biodegradable soap, so it is not too hard to rinse off.

Downtown Ntgatcha. Also known as "keep left".
Amani Hospital (the City of Hope clinic)
Cow xing
We definitely learn to appreciate all the nice things we have in the U.S.! I did our laundry today, quite a process in buckets and hand wringing. Dish washing seems to take at least one and a half hours with two people doing it. Today church was late because the kids had to go to the river to get water, we were running low. You should see them carry back these big buckets of water on their heads without even holding them!

City of Hope grows a lot of their own food, so the kids are up at 6am every day to work on the farm before going to school. They don't have high school at City of Hope yet, so the older ones have to walk 1 1/2 hours each way to school, that is a long day. Everything is so organized, and the children all seem to be so well behaved, friendly, and happy. I have only seen two adults in charge of them, one for the boys and one for the girls. They give a lot of responsibility to the older children.

Destiny Primary School, City of Hope 
Please pray for good health for everyone here, patients to give our students good experience while we are here (we were pleasantly surprised when we screened the orphans that generally their teeth were in great shape.  They have a regimented brushing program and most were brushing very well).  Also pray that all the orphans have a strong relationship with Christ knowing that he will protect them and love them.

I almost forgot to tell you, one of our students is so excited about learning this dentistry he is already talking about possibly going to dental school!

Dental patients
Examining the Children.
Cooking ugali. (ground maize mash)
I hope this letter has found you well and full of His peace.


Janet and Dee

Thursday, February 13, 2014

A Statement of the Problem

by Ty

The problem, as I have seen over and over again in different parts of Africa, is that Westerners typically assume that global health means doing what we do in America, just doing it at a different latitude. They think this way about health care, education, ministry, you name it, but let me talk about health care, which I know a lot more about.  This is a really bad assumption.  To counter it, I would ask these questions:

Are we even happy with the American health care system?  Most doctors and a growing majority of patients are not.  As Walter Cronkite said twenty years ago: It is neither healthy, nor caring, nor a system.  Well then why in the world would we want to unthinkingly export it?  It's not all bad, but I ask this: What part of the American healthcare system SHOULD be exported?  And what part should be quarantined?

Let's apply that to the American church while we're at it: What part of the American Church SHOULD be exported?  And what part should be quarantined?

My working hypothesis is this: We American Christians (and in particular doctors, who are a product of 30 years of our education system) are not really Christian in our basic assumptions.  We are humanistic reductionists with a Christian skin on.  Recently, a biomedical sciences professor, seeking to talk to a practicing Christian doctor about ethical practice, asked me about how Christian doctors typically handle a certain subject.  You know what I had to say?  I said, "Typically?  They do the same thing that everyone else does!"  I was ashamed to have to say it, but it's the truth.

Therefore, over the past 5 years, I have decided to work with students and residents at the Worldview level.  This is of the utmost importance, especially for people in training.  At least, I know that it is what I am called to do.  Better then teaching someone how to treat malaria and TB, or how to do a C section without electricity, or epidemiology, or whatever other technical skill/knowledge you can think of, I think it is more important to give Christian doctors a cohesive biblical worldview and understanding of health.  That's why I work in this little place in TZ.  Students get to work in our little clinic and see all the diseases of poverty, and to try to help people with some very basic resources (so far our clinic doesn't have electricity or running water).  AND during that time, I strive to get them to work out a biblical understanding of health.

To put it in an unkempt syllogism: 

Western Christian doctors are usually humanistic reductionists with a Christian skin on.

African Christians are too often animistic pagans with a Christian skin on.  If you put Africans and Westerners in a seminar together, they see these deficiencies in each other more easily than they see them in themselves.

Neither of these worldviews has a biblical understanding of health.  Meanwhile the Bible teaches people how to flourish (my working definition of health) on every page.  Think of the psalms about a flourishing tree planted next to a stream of living water. Therefore, an appropriate response to the situation is to seek to understand, and then transfuse others with a Biblical understanding of health.

To do that, you need to deal with:  What is Health?  Who is Man?  Who is God?  What are soul and spirit?  What is spiritual health?  What is the gospel?  What has it done to you?  What does it do to cultures/communities?  So we spend hours a day, sitting under an Acacia tree with our Bibles and talking about this stuff.  I think this foundational big picture stuff is the most important thing, and given one month with a student, I think it is the best thing to address.  Real expertise in malaria, TB, and HIV can come later, when a cohesive Christian philosophical framework has been developed in the student, and they therefore have a place and method to house the technical information.  I build the bookshelves.  Others will fill it with detailed books on technical subjects.  We do, by the way, then take our Christian framework and try to apply it to real problems, like HIV, reproductive health, malnutrition, etc.

This absence of a cohesive Christian philosophical framework for health and the practice of medicine is just as big a problem in the US as it is here--maybe more so.  I believe to develop and teach a biblical understanding of health is the antidote to our broken system.  It is the real "health care reform" we so desperately need.

My next seminar with a group of 15 students is in July.  In Jan, Feb, and March, we accept students and residents on elective rotations.  Lots of people would rather go to a big mission hospital and do something technical for the month.  But that is not what I think is needed most. 

I don't advertise this way, because it would scare people, but once they are here, a couple of days into the month, I often tell students, "You are here for a good brainwashing.  After the education you've been through, your brain needs to be washed."  They usually like that joke.  And assent to a being washed with the water of the Word.