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.

"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!

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 

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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.

 Blessings,

Janet and Dee

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.

How to fill a tooth in the dark — Building local capacity

By Ty

Imagine living as a farmer out here in remote Tanzania.  You have no cash in your pocket on a daily basis.  Now imagine that you develop a toothache.  The cost to get to the city (the nearest dentist, who often doesn't use anesthesia, by the way) is about ten dollars.  And it's another ten dollars to get the tooth pulled.  That's about what a goat costs.  And you only have two goats.  It would take you three weeks to earn that much money, if you could find a job, but there aren't any jobs.  So you just live with two months of excruciating pain, pus pouring out of the roof of your mouth, until your tooth finally falls out.  Or worse yet, your cow kicks you in the teeth, breaking off several in the front at the gum line. You save up fifty dollars over six months and you take a trip to the city to find a dentist.  Everyone says there is nothing you can do (unless you are rich, and you travel to the capital and spend $1000 to get your teeth fixed--but they don't even tell you that part because they know you're whole farm isn't even worth $1000).  You just have to live with that for the rest of your life.  Now you can see how valuable skills in dental care would be out here--how much you could help people if you had them, and how much you could help yourself.

That's why we're excited to be hosting a class in appropriate dental treatment for the next month.

In an effort to build capacity within the local community to improve their own health we happily welcome Dr. D and J, an amazing couple who are a dentist and a dental hygienist who have come from the states to teach a course in ART (Atraumatic Restorative Treatment) .  Most simply stated, this is how to do good dentistry in the bush, without electricity or running water, much less fancy technology. These good folks (and dear friends of ours) have gone out of their way to learn and then learn how to teach how to provide much needed dental treatments such as fillings, repair of broken teeth, and even pulling of teeth that can't be saved--all safely and relatively painlessly.

J. and D. teaching ART to the clinical staff.

Dr. D. oversees the students evaluating each other.

The class is attended by all four of our Tanzanian medical clinic staff , a City of Hope staff member, as well as a couple of other guests.

In the interest of helping nearby communities and health professionals, we invited two government clinic employees from neighboring communities.  We offered to give them the training completely for free (rarely do we offer things 100% free).  The invitation was extended by  Dr. B, the general manager of our clinic, who knows both of them personally.

Evaluating all the children at City of Hope (Little T. has 2 cavities...frown.)

Practicing on one another.

Their response was surprising.  They asked, "How much are you going to PAY us to receive the training?!"  They pointed out that when a particular non-profit organization with the word "population" in their name came to this region, they paid local nurses 75,000 Tanzanian shillings per DAY to listen to their training in how to hand out condoms (assuredly a simple activity)!  75,000 shillings is $50--what a typical farm laborer here would make in a month!

Why would anyone pay such a ridiculously high rate to "teach" someone population control...I mean, how to put on condoms?  Perhaps they are motivated by promoting their ideology?! (I will leave my population control rant for another day--the short version is that if you simply send girls to school, and help people improve their land and agriculture, there will be no "population problem".  Sub Saharan Africa is incredibly fertile.  She can feed herself. )

Furthermore, paying over-inflated wages is TERRIBLE for the local economy.  It leads to inflation of actual health care and other costs.  Why would a nurse sit in a village and treat poor people for malaria for five to ten dollars a day when she could sit in the city and make $50 listening to a westerner tell her how to hand out condoms?  Well, she might sit in the village if she could get $40 a day instead of $5. So what does she do?  She either goes to the city, leaving the poor with no help, or she charges the poor higher fees to make up for her lost "opportunity" in the city.  Look, if someone wants to offer seminars on how to pass out condoms, I won't argue.  I believe in a open and free market of ideas. They are welcome to try to offer their condoms as a way to help the poor.  But don't pay people RIDICULOUS sums to sit in your lectures.

I was pretty angry when I heard this.  I'm glad I wasn't face to face with the guys when they said they wanted to be paid to receive a free gift. which we were offering in an attempt to educate them and help their communities.  Because I might not have been gracious about it.  I said we are not going to pay them.  I still hope they come anyway.

Lest I spend too long astride my high horse, I shall get off now.  This morning I read about Peter's denial of Christ.  At the Last Supper, Jesus warned the disciples that they would disown Him and run away.  Peter vehemently denied this possibility.  Basically he said: "Others may do this, but I won't.  I would sooner die."  It was much easier for Peter be to critical of others than himself--to imagine others failing, but not himself.

I find myself asking:

How often do I do that?  How often do I find fault in others, when I am guilty of the same thing myself?

In what way am I guilty of the same thing I am critical of in others (witness my tendency to criticism above)?  How often does God give me a gift, and in return I demand to receive something for the act of accepting it?

How often does God send me a trial--for my own benefit--only to find that I demand some blessing simply for the obedience of tolerating the gift?

Our trials are gifts.  Usually we tolerate them at best.  Usually we want something good to be given along with the thing we can't help seeing as bad.  We want to be paid to tolerate our trials.  Rarely do we receive them warmly.  But why would God allow them if they weren't for our good in the end--even if we can't see that good now?

Our trials are gifts.  If only our hearts could believe it.

A Confession

Written by Ty

I have a confession to make.  I feel a pang of guilt every time someone in America asks me what I do in Africa.  I feel guilty because I fear I am not meeting the expectations I assume they will have when they know that I am a doctor and that I work in Africa.  They expect that I see patients and prescribe treatments eight hours a day.

The truth is that I don’t do much of that.  I do some of that—especially with the more complicated cases that the Tanzanian nurses request my help with.  I do go to the clinic often, but most of my time there is spent teaching—teaching the Bible and teaching medicine.

My calling is to teach.  It is to teach a biblical understanding of health as a philosophical foundation for helping people lead healthy lives.  This is not something I was taught in medical school.  In fact, I was taught essentially nothing in my training about a philosophical foundation for the practice of medicine.  Medicine, as it is understood and taught, is no longer about health.  This is true in the west, and because medical education in Africa has a strong tendency to emulate the west, it is usually true here.  In my experience, many health profession students in America cannot give me a good definition of health, and if they can, then they give me a definition that has little do with what they are being trained to do.  “You mean being healthy doesn’t have much to do with going to the doctor?” I reply in mock surprise.  “Yeah.  More like it means you don’t have to go to the doctor,” they tell me.  Basically, they are right.

But my confession doesn’t end there.  What we have now is a simple outpatient clinic that serves about 100 patients per week.  We need to go to the next level.  The small amount of curative care that we are providing is good, but it cannot be all that we are doing.  I don’t want this hospital to be just another mission hospital—a clone of many that are all over Africa.  I want it to be a place of investing in, teaching, and building biblical health and transformation.  Health is about so much more than pills and surgeries.  And if I spend all my time doing pills and surgeries, then I won’t have time to walk out my calling of re-establishing a biblical understanding of health as a sound and cohesive philosophical foundation for health care.

My confession is that I have been afraid to move the hospital forward because I have been afraid of it not developing into that place of health and transformation.

I’ve been thinking about: what do we need to do to go to the next level?  Will you pray with me about that?  I need discernment from God.  I think we need another person on the team—a doctor or nurse who can focus on doing some of the primary care, as well as work with our team on community health—building capacity within the community to do things that will foster their own health: such as education, agriculture, and clean water.  Will you pray that God will bring us the right person?  Maybe it’s you?


And some items for prayer:

Pray that God would give us discernment and resources in trying to take the clinic "to the next level."  I'm trying to figure out how to find and finance a full time community health worker--someone who regularly visits with leaders in villages and works with them to figure out how the community can improve their own health using their own resources.  Better water and better food are prime examples, and places where better use of already existing natural resources here could make a great impact on health.

Also pray that I am a good dad: that my kids know that I am available to them all the time, and that they are a higher priority than ministry.

ty