What will it take for you to volunteer overseas?

As doctor or a medical student wondering about medical volunteering overseas, have you ever asked yourself: “How can I do that? How could I really find the time and money needed in order to help out somewhere in the world where the need is great?”

First of all, volunteering overseas is not for everyone. Some doctors cannot adapt well to the unfamiliar practices and mindset of other cultures. It is unnerving when tools and support are lacking, and where it may seem like life is worth so little. Yet doctors are generally a pretty smart bunch, able to deal with a wide variety of personalities and perspectives, and many will do just fine.

But first you have to get there, which brings us back to the original question; however, the question must be rephrased. You cannot “find” the time or the money, as if they are sitting discarded by the side of the road, waiting for you to pick them up. The question that should be asked is: “Where is your time and money going, that you have nothing left to give?” What habits do you need to develop to change this situation?

Almost all American doctors are in the top 5% group of wage earners. So you are targeted deliberately and desperately by credit companies, stores, medical supply gurus, but also by your medical friends, culture, and surroundings to spend, spend, spend. Unless you decide early on and repeatedly to combat this onslaught, you will find yourself like most doctors: moaning over your debts and with no time off even years into your career, all the while making 4 times the national median income.

The strategy is simple, it only needs to be implemented. Cut the club membership and go to 24-hour fitness. Buy the Kia instead of the BMW; they are both have 4 wheels to get you here and there. You don’t have to buy the cheapest thing all the time, but you certainly don’t need the most expensive either. Do you really need the most recent i-phone, i-watch, or laptop? A flat screen in every room? Do you need to shop at Tiffani’s every week? If you are serious about helping those in this world with nothing, then you need to live with a little less. Perhaps most importantly: where do you live? Does it have to be the gated, golf course, sea-side neighborhood with a pool, or can you have a normal but decent house instead? 

As for time: you must guard it. Medical training takes nearly every second of your day, but you still have small bits here and there, albeit annoyingly unpredictable. Do not go golfing or skiing or out drinking every moment that you are off. Put some time into volunteering locally, going to church, or just taking a walk. Get used to saying no to non-priority duties. If you understand that the poor of this world need medical attention, you will be less drawn to more and more work and play here.

When you are interviewing, tell your prospective employer that you want to volunteer overseas. Most bosses are very sympathetic to this and will go out of their way to help you, but don’t take their sacrifice for granted. Let them know in advance if you are going to be out of town and need someone to cover for you. If you join a group, the same thing applies: tell everyone up front, during the interview, that you want to have some time off for volunteering regularly. Make it clear that you are looking for time in addition to the usual vacation. You can’t take all of your time meant for family and rest and expect to be working twice as hard overseas with no break. You may not need all the time off that some jobs may offer, but you need at least 2 weeks off per year that is actually vacation. Be ready to be paid a little less in exchange for volunteer time, and don’t expect everyone to appreciate you, though many will admire you if you stick with it.

Lastly, make connections that will help you get overseas. It is easier to walk this path with others who know the way. If you are a medical student, do not spend every elective month of your fourth year on an interview rotation; instead, find a program or position overseas for part of it. Many schools have international programs now, making it easy to get involved. You may not come back to something like this for many years due to residency requirements, but getting your feet wet early is very helpful.

If you have finished your training, find out who is doing what overseas and have coffee with them. Often these people are busy, so be persistent. See if you can tag along. Find out what your hospital or group is already doing, or what the churches in town are doing overseas. Contact one of the many groups that organize medical mission trips, choosing one that is reputable and allows newcomers. Your first trip does not need to be medical; but it needs to be service, not just vacation. Treat it like you are on a medical student rotation, even if you are a seasoned practitioner. If you go overseas like you know everything already, you are not going to be useful. There is more to say about how to prepare yourself culturally and otherwise, but that is another topic.

Every year, many doctors serve overseas and find it extremely rewarding. You can be one of them, if you develop the habits needed: protect your time, do not overspend your money, and make the right connections.

The Service Dog

  

"Jesus knew that poverty and disease in themselves are not the hardest things for people to bear; the hardest to bear are the loneliness and the hopelessness that come with being sick or being poor."
                                                                              -Shusaku Endo, A Life of Jesus

We doctors often poke fun of the service dog. We see the dog-lovers, obsessed with their dogs, bring them around the hospital to visit the sick.  What can they do, really?  Get in the way, pee on the floor.  

In America, various programs offer a safety net, a help, a support, to the poor, the elderly, the sick.  As I walk into the hospital every day, I am thankful that the patients can be cared with a high standard with relatively minimal restrictions due to the cost of care.  More so since the Accountable Care Act, otherwise known as Obamacare.  

Yet Endo reminds me of what else I see daily:  chemicals and surgeries leave a large gap in care, and perhaps inadvertently contribute to it.  When the care came out of love and sacrifice in the face of need in the form of a family member, a volunteer caregiver, or a nun, that love and spiritual connection was obvious.  When the care comes with a paycheck as a carrot and the threat of liability as a stick, the love is not so obvious, and may be missing altogether. 
 
Thank God for the opportunities to serve those who are suffering.  For God still calls His people to love.  We should learn from the service dog.  Never tempted to suspend presence with the patient to mix a medication or do another x-ray, the service dog is unpretentious to the core. Perhaps if Jesus were here today, he would say: "if any would enter the kingdom of heaven, let him be like one of these service dogs."  Sit with the patient.  Do not try to cure them, leave that to someone else for a moment. Listen.  Empathize.  Lay hands on them in prayer and communion, not only to cut them open. They may not live longer because of this.  But perhaps they, and us, will become more human.

Finishing

"And I am sure of this, that he who began a good work in you will bring it to completion at the day of Jesus Christ."
                                                                                  -Philippians 1:6

God will never disown you. He will never give up on you. He will never regret the price he paid to adopt you into his family. And he will never set aside the sanctifying process he began in you on the day of your salvation.

More than likely you will go through occasional times when God seems distant or you're losing your spiritual edge. In those seasons perhaps even your desire to grow in godliness will break down. But your feelings don't represent all that is true. God is still at work in you. In fact, many people will say that their times of deepest struggle became game-changes because of what they were forced to learn about God and life when put to the test. What was theory became belief. What was presumption became conviction...Because God finishes what he starts.

                                                                                  -Tim Grissom and John Majors

Work

"Do not work for the food that perishes, but for the food that endures to eternal life, which the Son of Man will give to you."            
                                    -Jesus (John 6:27)

How do you get up in the morning and go to work not for the food that perishes--not mainly for the profit?  This is really a spiritual discovery, attained through much prayer and longing...Yes, labor, but do not labor for the food that perishes. Go ahead and purchase, but act as though you have no goods. Do your business dealings, but stay free from them. The financial outcome of these is not your life...

Christ has lifted the curse of work. He has replaced anxious toil with trust in God's promise to supply our needs and has thus awakened in us a different passion in our work. We turn with joy to the call of Jesus: Seek the kingdom of God first...Labor to love people and honor God...Stop thinking mainly of profitability , and think mainly of how helpful your product or service can become.
                                    -John Piper, Don't Waste Your Life

Holes

“Am I leading a rebellion, that you have come out with swords and clubs to capture me?”

This is what Jesus said in Mark 14. He knew what was going to happen: in fact he had just explained it several times to his disciples both during supper and later in the garden of Gethsemane. He knew the disciples would all desert him: he had just been arguing that point with the Peter, who angrily thought he would be better than that. So the question is: why did Jesus ask this question? Surely he was not looking for an answer. In addition, he knew that in asking it, it would not change the course of events: he would still be captured, tried unfairly, and tortured to death by crucifixion.

One reason I think that Jesus asked this question was simply his emotional response to the situation. The injustice, the absurdity, the irony. As if he was overthrowing a government, or he was a master criminal. After all of his efforts put in to teaching these very people. After all the miracles, all of the work, all of the sacrifice, was this the result? A night time secret arrest by a bunch of thugs? Surely Jesus must have been upset at this, even if he knew it was to happen. Sad, lonely, even confused if that could be possible. No wonder he asked this question: is this really what is happening? Are you really going through with this? Et tu Brutus?

Are we who follow Christ to expect no confusion, no being forsaken, no betrayal in walking the pathway He walked? Do we expect no existential crisis when the world in its insecurity and vanity turns its back on us? No, more than turns its back on us: actually seeks us out to capture us, as if we were a danger and not a help. A threat and not a hope. A bringer of chaos and not what we are in reality: the hands and feet of Christ in the world. Remember that His hands and feet have holes in them. If we are his hands and feet, are we not to have gaping holes?

We will run away. We are more like Peter than like Christ. The crisis is too much, and we like all of the disciples bend under the pressure. But the life of Christ depends on Christ, is fulfilled by Christ, and is sustained by Christ. With Christ, the laws of mathematics are put aside and 1-1=1. When we fall, he does not. When the rooster crows, we cry; but even then Jesus is not finished with us. It is then he dies for us. It is then that his body sustains and His blood washes.

We have our questions, just as did Jesus. Like the holes in Jesus hands, there are pieces missing, things we cannot explain. Even moral and religious matters that gnaw at us and weaken us, draining out our life strength. But Christ is with us. He is our strength. Let us serve Him with all of our selves, holes and all. Be like unto Christ and wear those holes without shame.

How to Get Doctors to Small Towns?

The State of Missouri, using what has remained in State governance all of these years, the licensing of doctors, to make a very unusual ruling: allowing doctors without any residency training whatsoever to practice medicine (see article). This with the goal of providing medical care in rural areas.

This decision is short sighted and fraught with difficulties. It will serve to degrade quality and standards in the health care field. And yet it does illustrate the difficulty that the rural areas have in obtaining adequate health professionals in this country. And indirectly the failure of the medical education system to ensure the supply of doctors to rural America. This despite millions of dollars of loan repayments, various pilot projects, general guilt-tripping of students to goad them into primary care specialties, etc. Some fundamental changes must occur to reverse this trend and it is the responsibility of those in medical education and their f

und sources to ensure that this happens.

“Begin with the end in mind,” as Stephen Covey would say. What do we need to see? Doctors in rural areas need to be different than primary care in the city, where a multitude of specialists line up to compete for every possible disorder, especially every possible procedure. In fact, different rural areas need different things from their doctors: some may have a well-established OB practice and need primary care doc who can work in the ER. Some have ER docs and need some people who can do OB and ICU. Many need docs who can do psychiatry, since there is very little mental health support in much of rural America.

The current training system does not produce what the rural communities need. Residency has become more and more focused on producing sub-specialists. Primary care residencies such as Family Practice and Internal Medicine have become so heavy with top-down direction, that there is very little room for the innovation necessary to address the needs we are talking about. Endless streams of directions come from the central planners such as the Institute of Medicine, and the ACGME, ensuring that any possible change is nearly impossible.

In desperation, the State of Missouri has decided: this field in which training is done is too restrictive, and we are punching a hole in a fence. Maybe at least we will get some doctors out to our rural patients by doing this. I disagree with the specific decision, but I can certainly see the reasons for it. And if the organizations such as the IOM, ACGME, Medicare (holding the purse strings and thus basically guiding a lot of this), the American Board of Medical Examiners, and the specialty organizations tie the hands of the trainees and the trainers, then the states and the doctors and whoever can, will have to also help break down some of these fences, though hopefully in more strategic locations.

Some examples of things to try:

1. Pick out more procedures for the primary care to do that strategically expands the capability of the medical care provided in the rural setting: colonoscopy and echocardiogram interpretation are low hanging fruit, that could be incorporated into primary care training.

2. Form more residencies in rural medicine. Perhaps tailored to the specific community in need, and at the community level. In the age of the internet, a resident could train in the community he or she is to work in, with needed supplements of education and experience in larger centers and through teleconference.

3. Fusion of specialities: why make a “family practice” doctor and an “OB” doctor? Why not credential someone in those areas or subsections of areas that they need to do their job in their town? Board certification is a way of ensuring quality, but when it becomes impractical and stands in the way of patient care, it may be time to replace the process or the particular board, or both.

The Packing List

Fanny pack 

No longer stylish, but useful nonetheless.  When you quickly need bandages, a light, or gloves. Supplies are not as readily available as in a US hospital. For work in the triage tent or the ER.  We bought two fanny packs at REI, an outdoor store, before the trip.  One was way too big, so I’ll take it back after, unused.  My EMT niece and I shared the other one, trading off when the other came on shift.  Beth is my niece’s name; she wants to go to medical school.  I told her she needed Emergency Medical Technician (EMT) training if she wanted to go to Haiti with me.  So she did the class last summer.  Her nurse aunt and I guided her through IV practice on the relatives after family dinners.  Now she is pretty good.

Bandages and Chucks

Donated by Caroline from church.  Her husband was supposed to live longer, to need more home health.  But he left this world and the medical supplies were still fresh.   “Chucks?” the translator in Haiti said.  Like “Chuck Norris?”  “Yes, same Chuck” I laughed.  Refers to a large absorbent sheet with plastic on one side.  So useful when blood is dripping down.  To catch the life before it hits the floor.  Less messy.  Less dangerous than the splashing red.  For us, not for the patient.  For him it is less dangerous if he keeps his blood inside his veins where it belongs.

Cliff Bars

From Costco.  Very useful when hunger hits and rice and beans won’t come for several hours.  My wife bought two boxes for us before the trip.  I can’t stand going into Costco after a trip to Haiti.  Gives me nausea, even more than usual.  I take it out on the oversized cart--kicking it in the parking lot.  Why can’t someone even put it where it says “put carts here?”  How many suction machines could be purchased with one cart-load of junk food from Costco anyway?  Could have used another suction machine in the triage tent.  That patient, someone’s mother, hanging on by a thread.  Maybe if I had had another suction machine she would have lived.  Instead I rolled her over as the brown liquid no longer was vomited but ran out of her lifeless form, onto the floor, scattering the EMT’s like ants.  How much of that was from internal bleeding?  I will never know.  Autopsy is an unavailable luxury.  Need to move on to the next patient. 

Headlamp  

From Walgreens.  $12 on my visa.  Should have gotten two.  Or three.  So useful for guiding the needle while suturing lacerations.  Hard to see the needle sometimes at night, or during the day, when the curtains are closed to keep it cool.  I use the headlamp to crown a Haitian medical student so she can learn suturing.  Then for the trauma surgeon since I couldn’t stop a hand from bleeding.  Into a bucket this time.  Too much blood for even Chuck Norris.  A deep bleeder, since the knife had gone all the way through. “Tendons OK, though,” said the orthopedics doc.  Maybe he should have bought a headlamp, too.  On another case, he lost track of the needle long enough to poke his finger.  Wasn’t a big hole, but he looked down and there was a bit of his life oozing out in little red bump.  Only one drop, but enough to tell him the risk, bring the fear.  The patient with HIV, not on meds.  One in 300 chance of getting the disease himself.  He wandered a bit after the surgery.  What should he do?  What of his wife and kids back home?  He mentioned it to me and I whisked him off for “PEP.”  No, not a talk, but a month-long mound of HIV pills called “Post Exposure Prophylaxis.”  Reduces your risk of getting HIV from your needle stick. They have five days for you here, and you can pick up the rest when you get home.  Take some nausea meds, you’ll need them.  It’s the same approach we take in the U.S. with HIV needle sticks. 

Baby wipes

I don’t use them, but my niece does.  Some days when she can’t bear the cold grungy shower.  I am not afraid of the cold shower.  I find it refreshing actually, though painful.  You feel new after, not just clean.  But the violence of that cold water is not enough; more than just sweat gathers on me in Haiti.  And it seems I don’t deserve a hot shower.  How could I be pampered when down the hallway death approaches due to lack of adequate washing?  Where the water itself has brought death by cholera instead of the life and cleansing it is supposed to bring.

Glasses

I don’t really need them most of the time.  I can see 20/20 with one eye, at least after Lasik surgery, complements of the government, before I got out the Navy a few years ago.  But they help to read the x-rays, and God knows there’s no radiologist looking at them.  Except now there are some volunteers out of Duke helping out reading the CT scans.  That helps, except when I disagree with the read.  Hard to get a hold of them after.  Will have to leave that to the next team.  There is a European girl with several months of belly pains who comes for an ultrasound.  I talk her into a CT scan.  She can afford it and she needs it.  The radiologist from Duke says her adrenal gland has a tumor.  Let’s get her a copy of the CT; she will need that when she has a follow up in Canada.  They can compare.  See if it grows like a cancer or stays quiet, an unseen blemish of no consequence.  We hope.  I see fear in her eyes, and I do my best to speak to it.  Speak to God of it.  She has worked hard for the people of Haiti.

Pens

I always bring a whole box.  As a doctor, the last thing I need to worry about is whether I have a pen in my pocket or not.  So I don’t care if I leave them here and there around the hospital, even in the States.  If someone needs one, I hand it over.  Though at the same time I always bug the med student if he is unprepared.  They need to grow their anxiety a little sometimes.  Can’t be a good doc without some anxiety.  Didn’t know the pens would be so busy this time on a certain form:  the Haitian death certificate.  We write in English, trying to understand the form in French.  Getting the name right is easier this time, due to the printed intake form from the hospital’s new computer system.  In the Sates, I get the forms back months later:  what sort of cancer was it?  What stage?  Was it treated?  Usually I can figure out the answers to these questions by looking back through the chart.  But in Haiti the cause of death is more often a guess.  And the box of pens does nothing to make it clearer.  Nor can it hold off the power of death.  The trauma surgeon tried to take it in stride with a joke:  just fill out the death certificates when they arrive, he said, and save our time later.  The black humor of his trade; shared with soldiers, morgue workers, and the like.  I try that kind of humor some, but that shield for me is incomplete.   What gets through gathers in the pit of my gut somewhere and gnaws.

Sun block

My white skin is an extra chore, but something I can afford.  Trying to prevent a painful burn and slow the lines that are forming from various adventures.  Skin cancer risk doesn’t bother me.  I can’t fathom having it, though I have treated enough of it on others.  I bring for a week more than I can use in a month.  The excess margin our culture carries around.  Too much sun block above the eyes and it runs down in the mid-day heat and burns my eyes.  

Books

I never have much time to read during my week of work at the hospital in Haiti.  When I am off shift, there are interesting people to talk to, quite the adventurers that volunteer their time.  Some quite wacky, maybe they can’t function in America.  Unfortunately the third world gives them default leader-status, at least at first.  But most are admirable, self-giving, and illustrations of a Covey Highly-Effective book.  The airplane ride, though, gives me reading time.  It is a long way from Seattle to Miami, and layovers to make the flight cheaper are also prime reading spots.  I bring a devotional to read in the early hours before I start work.  Crucial to forming spiritual energy that rapidly depletes during the long, draining days.  My book Authentic Faith by Gary Thomas says  “Our attitude toward God is defined by our actions toward the less fortunate.”  I share a passage with one of the nurses as she feels compassion fatigue:  “As you begin to reach out to the hurting, it’s important to check your sentimentality at the door.  In reality, it’s something we need to do with our eyes fully open.”  On the plane I read a less encouraging book: When Healthcare Hurts, by Greg Seager.  After that, one realizes that there is even more hard work to be done here:  Balancing helping and giving with critical and scientific analysis.

Batteries

Didn’t need to use them.  The new headlamp lasted the whole week.  And I hardly used my otoscope this time: between the pediatrician helping me in the ER and just randomness I think, there were not too many ears to look at.  Probably should have left the C batteries in Haiti for the laryngoscopes.  It is difficult to keep the laryngoscopes ready for the next emergency.  This kind of code needs an Intensive Care Unit (ICU).  This hospital has one, an ICU that works.  The ICU is a major step up in complexity and cost in the third world.  It takes many batteries, along with working ventilators, trained ICU nurses, loads of equipment with a working supply chain, and many, many other things.  Though it doesn’t have all of the bells and whistles (and extra redundancy) of a high acuity hospital in the U.S., this oddly partnered hospital in Haiti has walked up this difficult step and is sustaining.  Probably has taken much more investment in time and money and training than anyone would have anticipated.  Someone should write a paper about it, I ponder.  Not me I hope; musing is more my line.  I put the batteries back in the garage when I get home.  A room that holds 2 cars and the boxes and bikes and lawn care stuff of an American family.  Seems wrong, like the Costco cart.  If this room were carried to Haiti, it could be another ward full of patients.   I could have accepted another person to the hospital.  Could have saved a life.  Lives for toys it seems.  Lord, have mercy on me. 

Deodorant

Seems rather pointless to put it on only once in the morning.  Like using a teaspoon to drain the ocean when I am on duty in Haiti.  Maybe it helps more when I am out of clothing and what has aired out on the bunk bed is going into service for another round.  Smelling good is another luxury.  When my wife and another niece pick us up from the airport, they are not shy to encourage us to visit the shower when we get home.  Walking around Miami in veteran Haiti underwear and then flying just did not produce an appealing fragrance for them.  Perhaps we should have sprayed on some perfume from the duty-free shops.  

Shoes with no holes

It feels like my feet are cooking in these shoes.  But flip-flops just will not do, with blood and needles and cholera.  The first time I wore these shoes here, I thought I would throw them away after.  With the bleach from the cholera tent and the ubiquitous dust from the earthquake rubble, they were not pretty.  But a shoe shine later in the Chicago airport and they were good as new.  Had them back three times since.  The first couple of times in Haiti I wondered why my legs were so swollen.  But my doctor buddy in the Navy explained heat edema to me, having had the same puzzle in Iraq.  A transient problem as the blood vessels dilate in the heat, probably worse with the salty Caribbean food and long days walking around the hospital grounds.  Beth added to her discomforts this edema and a significant reaction to the mosquito bites with quite a bit of pain.  I had to reassure her that, no she was not going to die or be disabled.  She got it.  Tears she had, but she kept them away from the patients.  During the work day, she kept a smile on her face.  That and management of chaos, skills of value ingrained in her over high school years of part time work by the McDonald’s corporation.  Who knew that Ronald would be so helpful in Haiti?

My Traveling Hat

I am very particular about my traveling hat.  This is my third over the years.  Brim bigger than the current fashionable Fedora.  Soft and wool made, so that unlike a cowboy hat, it can be crushed and bounces back to its original shape.  Helps protect my over-white facade, and makes me feel a little like Indiana Jones.  No whip though, and women don’t chase me.  I do enjoy the adventure part of these trips.  It is exciting to be there in the midst of the action.  Some are quite addicted to it, signing up for long stents with Doctors Without Borders or moving to places like Haiti full time.  I am taking it in doses.  Need to be careful not to overstep my bounds.  To avoid doing medically overseas what I cannot do well.

Money

Small bills, they said.  For tips, for food, for souvenirs.  Needing more and more each trip.  As Haiti rebuilds, there are more things to do, more ways to spend your money.  The massive fields of post-earthquake tents are gone.  There are parks again, stores.  Back to urban sprawl.  When does post-earthquake camp change back to urban slum?  Perhaps in part defined by whose hands the money passes to and through.  The shop owner now, not the developer so much.  And still there is hunger.  Still orphans and knives and no margin.  An odd, odd thing, money.  Can cause so much damage and so much good.  A thing of faith and a thing of filth.

Passport

I always carry it on my person.  I don’t know really if that is safer than leaving it in the room.  Nothing seems to get stolen out of there.  And if someone came in with a knife and wanted my passport, I am sure I would part with it rather than part with an organ.  But I doubt that would happen, with our fenced area and our guards.  Our bunks are in the back hallway of the small hospital.  Formerly private rooms for patients back before the earthquake put things on top that were on the bottom and vice versa.  Many third world hospitals are like that:  a large open ward for the poor, and private rooms for those who can afford the rent.  It helps the hospital stay afloat.  Now they are just starting to reintroduce billing, a transition back to having the patients pay.  But it is only the open bay patients now; the private rooms are still filled with volunteers.  Hard to say what is better for the health care system and the patients: not paying or paying.  But those decisions are, appropriately, in the hands of those who don’t need a passport to live here.  Of course the passport for me is the final thing on my list.  Gets me on the plane out, back to the U.S.  Don’t even need a ticket any more really:  it is an idea rather than a piece of paper, accessed by the passport.  Who you are, or who the government and the bank define you to be.  Another book of faith.  Not as solid eternally, but it helps for now.  Means to an end I hope.  The many stamps in my passport reflecting a love: for the world, for cultures, for people, for life. 

Watch and Pray

“Watch and Pray that you will not fall into temptation.  The spirit is willing but the flesh is weak.”   

                                                                                                                  - Matt 26:41

This is what Jesus told his disciples after their Passover meal, full of rich food and plenty of wine.  When they had gone out of the city of Jerusalem and into the hilly woods where they usually slept when they were visiting this city.  For Jesus’ followers, it was the end of a happy evening, a time to retire to bed.  They were already nodding off when he spoke.  To Jesus, it was his last few hours of freedom, he knew to be followed by horrible terrors and then death.  He asked them to watch with him, stay awake with him while he struggled in prayer.  He wanted their company, their support. 

“Watch and Pray” is the command of God.  We the people of God are like the disciples:  not really interested in either one.  After a good meal, and more than a little wine (holy meal, holy wine, given to us by the Lord himself), basically we just want to rest in a blissful sleep.

The reality is, despite our happy feelings and desire for rest, this world is not our home and in fact disaster is coming like a freight train without breaks.  With us resting in the middle of the tracks.  And so Christ calls:  “watch and pray.”

It is natural to sleep.  Mentally healthy.  Attractive.  Balanced.  It would only make sense to watch and pray if there were something more.  Something more than is seen, is measured, is known.  Only then would it be not only reasonable, but in fact necessary. 

Jesus does not advocate neurosis.  He is not saying to us that our goal is nervousness and irritability.  Religious efforts often seem this way, and in fact often are.  For our own efforts at seeking God, separated from us by too great a distance for our own abilities to overcome, can only be an agitated and pointless scratching.  A swinging at the air and a speaking to shadows.

Jesus is our only hope in this matter.  Of all people, he alone had no wasted words, no lost actions.  What he said had authority (and has authority).  When he spoke, the lame walked, the blind saw, the dead were raised. 

And what Jesus said to his followers and to us, he said that we might know him.  Know the person of Christ.  Know him in complete salvation, a knowledge beyond knowledge.

The rest of the story is that every one of the disciples fell asleep.  And that more than once.  Their watching, their praying was obviously inadequate.  They did not save Jesus from death.  And they did not resist the temptation to disown him one by one.  And yet Jesus, the one forsaken by all, in the power of God and not of man, rose from the dead.  Showed himself completely able to do all of the work needed to save all of us.  And in the fulfillment of his task, Jesus in his mercy used his disciples.  Before, during, and after his death and resurrection he allowed them to be part of his glorious work.  Despite and even through their failures.  It was as if that was exactly where he wanted them, at the end of themselves that they might look up and see him.  They thought they were assistants, but their work was ultimately to become witnesses.

Rest in this.  Accept it.  Know that Jesus can save you.  Know Jesus calls you also.  Calls you to follow him.  Calls you to listen to his words.  Calls you to be in community with others who are also following him.  And calls you too to watch.  And to pray.  And most of all calls you to witness what God is doing. 

A Week In Haiti

At the end of June, I went to Haiti again to volunteer for a week as a doctor at Bernard Mevs Hospital, with Project Medishare.  That is me the tall tired looking one in the courtyard.  John is my brother-in-law who came along as a great support staff!

Most of our team for the week.

Still so many tents!  Not an easy place to live!

John learns how to make a leg at the prosthetics lab!

To learn more about the organization, you can visit the Project Medishare website.

To read a more detailed report of a night working in the Emergency room, please click here.

Thanks so much for supporting and praying for me and everyone trying to help out.  Please remember the people of Haiti, so many struggling and working and serving to make things better.

A Week In Haiti

Part of a Tent City -- Too many still there

56 year old female diabetic with necrotizing fasciitis and sepsis had left above the knee amputation is still on the ventilator after surgery…

12 year old female with total body paralysis with multiple complications on the ventilator…

46 year old man with non-healing ulcer on the thigh for unknown reason, has been here on antibiotics for 2 months…

Your food will show up on your bed (down the hall from the patient wards) at 10 am and 2 pm, you can eat it when you like…

You are not to leave the hospital compound for any reason.  The election results are coming out and there may be riots…

In the ICU

Cholera patients are to be stabilized and then sent to the local cholera treatment centers.  Make sure to decontaminate with bleach when leaving the cholera treatment area behind the hospital…

Words of introduction that we received as we checked in to the Bernard Mevs hospital in Port-Au-Prince, Haiti on New Year’s Day, as the outgoing team prepared to leave in the afternoon back to Florida.  I spent the week as the main inpatient doctor for this small hospital in Haiti’s capital.  I was with a team of doctors and nurses from the States, working with Haitian doctors and nurses caring for some of the sick in a country that has seen much hardship.

One of the Surgery Cases - Dr. Seth

I have gone on quite a few volunteer trips over the years, and I thought this one would be somewhat different:  I was right.  Teams from “Project Medishare,” have been rotating through on a weekly basis regularly since the earthquake last year, first in a tent hospital at the airport, and for the last several months at the current location, partnering with an already-established hospital.  Initially very busy with surgeries on the injured, now the focus is more on medical conditions and rehabilitation, though new trauma patients also come in.  And of course there is cholera.

The week was very full.  We treated many patients with high quality medical care.  Despite language and culture barriers, the Haitian staff and the American volunteers worked well together.  The numerous translators of course were indispensible, and it was fun to use my French skills, which have been rusting over 20 years of disuse.

Highs and lows included seeing the 12-year-old girl get transported to the U.S. for more care, through the generosity of many kind donors.  Seeing a spinal injured patient get stable enough to reach his goal of going home.  Losing a severe cholera patient to a sickle crisis after successfully pulling him back from death once.  Teaching Haitian medical students.  Every day was full of interesting and demanding medical work. And I was able to grab a few precious minutes alone with my Bible in the mornings in a secluded courtyard.

In the hospital Courtyard

Jennifer asks me: what did God teach me through this trip?  Probably several things:  That it is difficult to get a good understanding of peoples’ suffering by watching television.  That simply doing a good job in your field is of great physical and even spiritual value.

I must thank God for providing the opportunity to go on this short trip.  And also those who prayed and supported me, not the least of which was my wife Jenifer who has to care for the household while I am away and is a trip-organizer extraordinaire! 

Why do I keep up with overseas volunteering?  Several reasons probably:  I want to make a difference.  I hope to be of help where the need is great.  It is very interesting medically.  It is an adventure.  I find other cultures and peoples fascinating.  But I hope and pray most of all it is the Lord Jesus working in and through me in His love, in spite of myself many times.

Dr Barry, Dr Paul and Translator

Please continue to remember the people of Haiti in their suffering.  There are many worthy people there who love their country and are doing their very best to make it better; pray for them and for God’s mercy in their rebuilding, and the battle against cholera.

Paul Bunge, MD

P.S.  You may be interested in helping out financially with some of the projects in Haiti.  Consider one of the following agencies working there:

Project Medishare

www.projectmedishare.org

Samaritan’s Purse

www.samaritanspurse.org

And to fund scientific research into spinal injuries, consider the University of Miami’s “The Miami Project to Cure Paralysis”:

www.miamiproject.miami.edu

Not To Be Ministered Unto

I read this initially as a teen, and I pull it out (or as is the case now, open it on my computer) about every year or two to give it a good read. It really hits me square whenever I do so I hope helps me. An old-time Salvation Army Officer wrote it I believe, and Keith Green's ministry reprinted it in the 1980's as I recall. Read it slowly and carefully if you want a challenge:

Not to be Ministered Unto

"Gifted"

Moses told the Israelites, “See, God has selected Bezalel son of Uri, son of Hur, of the tribe of Judah. He’s filled him with the Spirit of God, with skill, ability, and know-how for making all sorts of things, to design and work in gold, silver, and bronze; to carve stones and set them; to carve wood, working in every kind of skilled craft."

What does it mean to be "gifted." We use that term but we don't really mean it. What we mean is that someone is really good at something. Or they pick things up easily. They get A's without trying (or it would seem to others). Working with some very high-achieving Asian-American students, I have been contemplating what it means to be gifted. What kind of goals should someone have who is obviously so successful in school? What does God have to say to folks like this?

Well, Moses had a word from God (one of many, some would say too many after trying to read the book of Leviticus). And this word was had to do with this guy Bezalel. Someone obviously gifted in many areas. A superb craftsman. One wonders if he did work for Pharaoh in building and carving. In any case, Moses did not call him a "high achiever." He did not call him an "expert." Moses looked upon the man and the situation first from the perspective of what God was doing and who God is. He said that God selected Bezalel. He said that God filled Bezalel with His Spirit. And it was this same God that GAVE Bezalel the abilities and knowledge and skills.

This is a major jump in thinking. Do not think that this is a word game. This is more than an idea. This is foundational for life and work and everything. Moses is speaking the Word of God. Hear it. Digest it. Live it. God gave Bezalel his abilities. That of course does not mean that Bezalel did not train. That does not mean that Bezalel did not work hard, that he just sat in church and lifted his hands and all of a sudden he was an expert. But Moses is speaking to you and I, because we lose track of who God is and where our abilities come from. All good gifts come from God. All abilities come from God. And sometimes, God especially blesses some people with unique and wonderful abilities and talents to use for His purposes.

Bezalel was one of these people. And God used Bezalel to supervise and train others in the building of His tabernacle, the very ornate tent that went with the Hebrews through the desert and to the promised land. The tent that God met with the people, where God spoke to them and where they worshiped Him.

So what should we do with the wonderful talents that God gives to us? Here is a short list:

1. Develop them
2. Rejoice in them
3. Thank God for them
4. Offer them to God for Him to use as He sees fit
5. Look for others who know God, to help guide in appropriately doing #4
6. Realize that sometimes it can be lonely, being the one with so many talents and abilities
7. Realize that others need those talents and abilities since they do not have them
8. Realize that being used by God will make you feel like you are being used (sounds obvious but you won't like it sometimes)
9. Realize that there will always be temptations to use talents and abilities for self-service and for the world's and the devil's purposes
10. When you see God's gift to others and not to you, rejoice and thank God--do not turn to jealousy or try to run that person down

The best perfume

"And Jehovah said unto Moses, Take unto thee sweet spices, stacte, and onycha, and galbanum; sweet spices with pure frankincense: of each shall there be a like weight; and thou shalt make of it incense, a perfume after the art of the perfumer, seasoned with salt, pure and holy: and thou shalt beat some of it very small, and put of it before the testimony in the tent of meeting, where I will meet with thee: it shall be unto you most holy. And the incense which thou shalt make, according to the composition thereof ye shall not make for yourselves: it shall be unto thee holy for Jehovah. Whosoever shall make like unto that, to smell thereof, he shall be cut off from his people." Exodus 30:34-38

God was busy telling Moses how to make his portable worship center for the Jews to have as they traveled around the desert after being freed from Egypt. So what is up with the perfume? It says how to bake up some nice spicy perfume to have around the sacrificing area. I wonder what it smelled like in there, a lot of burned fat mixed with new blood splashed everywhere mixed with old blood from previous splashings. In any case, incense was also to be part of the smell. My question is, if they have some great recipe for a good smell, why restrict it to the temple? What is the deal with this instruction at the end: do not make any on your own, just because you like the smell? Surely there is some other bad smell that needs covering up. No flush toilets and no refrigeration makes for some toxic fumes!

God wants the best for himself. And His instruction to His people is to bring Him the very best. Not the left-overs. Not the side-jobs. And not only the first bit, but the best of the best is to be for God. And still now, God wants this from us. It is what God deserves. And it is what makes us connected with reality and truth in the most real way: Bringing God the best that is in us. The best that we can make. The best that we are. That belongs in the temple of God, in worship.

So, when we give to God in our gifts to the poor, are we bringing the left-overs? The stuff we don't want from too much shopping in the clothing section? When we go to church, do we make sure we have maximized our fun time the night before, even if it means sleeping through the sermon? Why are our church programs look like so many left-overs? Why are our fellowship times filled with distraction? Is it not that we do not bring the best to God? Is it not that we are busy making perfume for ourselves that belongs in God's house?


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