Saturday, June 24, 2006

Thankful for what we have

There are those who have and those who have not. It is this very issue that brings me to write about an event that in itself is horrific, but in general is reality and worthy of sharing, if for no other reason, than to make us all aware of what we have or have not.

It is common practice in Cambodia for three to five people to ride on a small motorbike to get around. Usually it is a family, the father driving, a small one or two year old on his lap holding on to the handlebars, a toddler right behind him, and the mother on the back riding side saddle. This event involves the toddler who for whatever reason, fell off the bike, and in landing in the street proceeded to break both of her forearms and wrists in 3 or 4 places. A missionary happened to be in a truck directly behind the accident, and stopped. He picked up the child, put her and the family in the truck, and drove them to the local hospital. He dropped them off for medical care and left. The next day he returned to see how the little girl was doing only to find the mother wailing in the street, clutching her one year old, and the father catatonic. The missionary asked where the little girl was, and was led to a cot. There lay the little girl with both her arms amputated at the elbows. He was speechless. When he could talk, he grabbed the physician and demanded to know what happened. The answer was simple: the family had no money, and without money, there would be no surgery to place pins, screws, and plates to fix the fractures. There would be no casts, and no follow up care. No money, no medical care. It was decided that the best thing to do would be to amputate the forearms, as the surgery for that was quick, and the care needed afterwards was minimal. And that was that. No consent, no discussion, no remorse. It is this very event that was shared with me that made me realize that in fact we are those who have.

What we have here are conflicting values. Here was a physician who is supposed to act as an agent of good, but does evil. But in his defense, could he have done anything else? The culture, the environment, the demands, and the expectations would not allow him. Trying to do good things for people can be very hard indeed. Look at our own environment and culture: managed care regulating what we can do and those who are without health insurance demanding care and procedures that are beyond the reasonable. We work in a medically privileged society, primarily because we have. That family in Cambodia had not, and they paid dearly for it.

I don’t try to explain these kinds of events because they can’t be explained. Some things in life just happen, and maybe they have a reason, and maybe they don’t. In either case, the best we can do is to remember and learn from the moment. I studied medical ethics under Dr. Pellegrino at Georgetown, and remember the words he ingrained in me daily: “health care is not a commodity but a human good.” That simple statement continues to give me reason to keep on caring for children who are ill and injured through no fault of their own. Look around at our own lives and be thankful for what we have, and ever mindful of those who have not. That might not be enough for everybody, but it’s enough for me.

In all things, give thanks…


copyright 2006

The Mission of Mercy Medical Clinic in Mbabane, Swaziland

It's done. Ray Eynon, a friend for years and a brother in Christ, took my ideas and thoughts on how a medical clinic should flow, and put it down on paper to fit into the foundation and structural walls of a common Care Point building. Ray is a well known architect in these parts, having designed many churches, and worked with me in building a medical clinic in Mexico. I'll be in Mbabane the early part of August and will see the clinic as it is going up. It should be ready for our medical team when we arrive in October of 2006. It will have 2 exam rooms, a nursing triage station, a waiting room for 20 patients, a lab, a pharmacy, storage and 2 toilets. Pictures to follow.


Wednesday, June 21, 2006

Swaziland Discovery Trip March 2006

March 14 – 19, 2006


Four in every 10 people in Swaziland are HIV positive. The life expectancy is 33 years old (2005 estimate) and is expected to drop to 30 years old by 2010. A third of all children are without parents. Half of the patients in the hospitals have AIDS, and an estimated 50,000 people are dying each year from AIDS. Most AIDS victims never see the hospital and die at home most of the time alone. The orphaned children are who we are concerned about, and it is with that in mind, that I went to Swaziland to look at the medical care available for the “Forgotten Children” cared for by Children’s Cup and Mission of Mercy. The result is both encouraging and overwhelming.


Swaziland is a country slightly smaller than the state of New Jersey and has a population of around 1,173,900 people. The figure is inaccurate because of the AIDS pandemic, the lack of current census data and the lack of documentation of those who die or who have HIV/AIDS. Swaziland is a land locked country in the north eastern portion of South Africa and is a monarchy. Agriculture occupies more than 80% of the population and the country is heavily dependent on South Africa from which it receives about nine-tenths of its imports and to which it sends nearly three-quarters of its exports.


Medical care is far from adequate. The hospitals are antiquated, the equipment is non working and the facilities are dirty, crowded and poorly staffed. Nursing staff are obtained from local training programs which in themselves do not have enough teachers to educate the students. There is no medical school and those who wish to become doctors travel to other countries to receive their medical training and do not return. The doctors who are practicing in Swaziland are from Cuba, Zambia, Egypt, Ethiopia, and other outside countries. I was not able to determine their quality of education, nor their clinical competency, although I met 3 doctors, 1 of whom seemed average in his knowledge base, 1 Cuban doctor who I could not evaluate, and an Ethiopian pediatrician who had a personal bias towards palliative care for children with HIV, citing the futility of trying to treat children with HIV/AIDS only to have them die anyway.

The 2 hospitals we visited were as described above. The first, Raleigh Fitkin Hospital, is a Nazarene associated hospital, with some confusion as to who actually owns and runs it. The second was the government run hospital, Mbabane Government Hospital. The wards and the outpatient clinic were both below standards even for a comparable under-developed country (Ethiopia for example). Physician availability was marginal if non existent and nursing care was absent. The Matron of nursing shared that the nurse to patient ratio during the day was 1:25-35 and at night was 1:45. This would eliminate any care what so ever for a patient from that nurse. The wards were crowded, and babies were lined up on a table side by side, with their mothers standing at their feet with no place for them to sit. The babies we saw ranged from 1 month to 1 year, all with IV fluids running, and all clearly critical. We saw 8 babies one afternoon, and when we returned the next day, 2 of them had died during the night. I had asked the pediatrician about aggressive care for the babies, as it was clear to me that several of the babies needed additional care and intervention. He remarked that they are “heroic” and described their intervention, but it was hard to believe that it was done. There is no equipment available to do what he described.

The out-patient clinics were crowded and always full. There is a VCT clinic (Voluntary Counseling and Therapy) where patients would go on their own to be tested for HIV and counseled and started on anti-retroviral (ARV) therapy. The follow up on these patients was admitted lacking as stated by the counselors. Many patients never returned and therefore the number of people with HIV/AIDS and the mortality rate is inaccurate.

An exciting project exists on the other hand. Baylor University in association with Bristol-Meyer has a brand new outpatient pediatric clinic for children with HIV/AIDS. We visited it and met 2 American pediatricians who work there. The facilities are modern and clean. It has just opened and serves only children with HIV/AIDS and their families. We established a relationship with them for referrals.

We met with SwaziPharm, a wholesaler of medications and equipment in order to establish a relationship for the purchase of both medications and equipment. We toured the facility and were impressed with the inventory and feel that it will serve as a resource for our medication and equipment needs.

A mobile clinic was seen that was bought to Swaziland by a volunteer organization and has a fully functional dental chair with equipment run by a generator. It is a converted horse trailer and fairly large, but will serve well for the dental part of medical missions.


Care Points serve a resource for holistic care for orphaned children. The medical component is what I looked at, and Children’s Cup has done a wonderful job of providing healthcare to those orphans. Teresa Rehmeyer who is a missionary and a nurse, cares for all the children served by the Care Points, giving basic medications and healthcare as needed and referring those who need advanced care to local hospitals and clinics. Each Care Point has a small room that is designated as a medical room and is stocked with basic medications.

Mission of Mercy will be building 3 Mercy Centers, physically the same in structure as the care Points, and similar in holistic approach as Children’s Cup.

There will a total of 12 centers serving approximately 3250 orphaned children. That number alone dictates the need for a comprehensive medical system solely for those children.


With 12 centers and approximately 3250 orphaned children, the establishment of a dedicated medical system is recommended. This can be accomplished using a 3 tier system, all of which is either in place or obtainable. Meeting the healthcare needs of these children early will help prevent long term effects of chronic illness and perhaps prevent devastating terminal illnesses.

Sunday, June 18, 2006

In the beginning....

1 Thessalonians 5:16

There is never a better time to change how we look at life, than when we are told. Over the last 18 months, life has changed, priorities have changed, and God' purpose for me has become more clear. I began a loose association with Mission of Mercy in November of 2004, taking a medical team to Cambodia, and have made 8 trips there since. The relationship with Mission of Mercy is now formal, and more countries have been added, visited, and planned for.

Things have been moving at a pretty brisk pace over the last few weeks. Many of you have either participated or have declared a desire in your heart to be a member of the medical team that serves the “Forgotten Children” in countries served by Mission of Mercy.

I resigned as Medical Director and Division Chief of Pediatric Critical Care at Phoenix Children’s Hospital in order to follow God’s command to serve in counties where medical care is lacking. I am blessed to be a part of Mission of Mercy serving as their Medical Director, assessing, coordinating, implementing, and delivering medical care to the countries and children they serve. I am still working full time as an intensivist at PCH, but my time off clinical service gives me the opportunity needed to travel. The schedule is hectic, but purpose driven. Since we have started doing our medical trips, you and I have made 8 trips to Cambodia in a year and a half, and have cared for over 10,000 patients. Most importantly, over 10,000 people have witnessed Christ through our work. Our work continues.

Let me go over who the key players are. There are 2 people at MOM who I work with and who support our mission: Jack Eans and Wayde Goodall. Both are passionate about our work, and are excited about what we do. Don Christensen is our “benefactor”, finding funds for us when we need them the most, and working by our side as a member of the medical team. Dr. Troy Nelson is my brother in Christ, having served with me on every single medical trip so far. Kelly Ramsland is my right hand person: she is the “administrative” side of the ministry. All of you have served in some capacity on each team and for that I am thankful.

I have also made several assessment trips this year to countries in need of medical care: Jordan, Gaza, Ethiopia, Egypt and Swaziland. As a result we have identified and begun medical intervention programs in several of those countries:

Egypt: in Cairo, there is a “garbage city” that has a 4 story school house in the middle of it; I identified a floor that we will be building into a medical clinic with exam rooms, a small lab, etc. This will be available for our team when we go there.

Ethiopia: in Addis Ababa there is a medical clinic that will be established for the care of over 2000 MOM children. This should be available for our team when we go there.

Swaziland: we will be starting construction on a medical clinic this month. This should be available for our team when we go there.

Cambodia: we built a medical clinic in the Salaa Hope School in Battambang.

As a result of the assessment trips, I have identified dates for medical teams to those countries. I have also several more assessment trips that I will do next year to add to our list of countries that need help. The table below gives you the dates for the assessment rips, the medical trips and the training trip. I am showing you the whole picture so you can get an idea of the vast scope of the project.

Training trip: Aug 3 2006-Aug 12 2006 Swaziland
Medical trip: Oct 5 2006-Oct 15 2006 Swaziland
Medical trip: Feb 9 2007-Feb 18 2007 Egypt
Medical trip: Mar 23 2007-April 4 2007 Swaziland
Assessment trip: April 16 2007-April 22 2007 Bangladesh
Assessment trip: May 5 2007-May 13 2007 Kenya
Medical trip: May 11 2007-May 20 2007 Ethiopia
Assessment trip: June 4 2007-June 12 2007 India
Assessment trip: July 26 2007-Aug 5 2007 Romania, Kyrgyzstan, Lebanon
Medical trip: Oct 19 2007-Oct 28 2007 Cambodia (Dr. Troy Nelson to lead this team)
Medical trip: Oct 19 2007-Oct 28 2007 Swaziland

As you can see, there will be 6 medical trips, one of which is already filled. We are going to have 3 trips to Swaziland since there are over 3000 children there that need our help. Cairo will be interesting as well, with children living in garbage piles who need medical care, and Ethiopia will be in the heart of Africa with over 2000 children who need to be seen. Please let me know and Kelly Ramsland as well which trips you would like to go on. The costs will be between $2200 and $3000 per trip depending on where we go. Kelly should have more details as we move forward. We are using Cain Travel (Lori) as our travel agency. Kelly will be responsible for all administrative stuff: travel, arrangements, etc. She can be reached at 480-250-7183 and at

I thank you all for your dedication, your commitment, and your Christ driven purpose. We will move in the direction He sends us, doing what we can, knowing that we are simply His servants. Please call me, email me, or see me if you have any questions.

In all things give thanks,


Saturday, June 17, 2006

Who am I....

It seems that in our culture, old age is seen as a repairable condition rather than a natural end to the rhythm of life. Every where I turn there are ads for looking younger, feeling younger, becoming younger, and just plain pretending to be younger. At my time of life, age is becoming more of an issue, and less of a celebration. As each year passes, I pause to wonder how much longer and how much vitality I have left. So, I make the best with what I have and move as quickly as I can, catching my breath and looking forward to the next heartbeat. And then I sit and rest and reflect. A little over dramatic, but it’s the concept that needs exploring and that’s what this little piece is about.

A few months ago, while flying back from the Middle East and Ethiopia, I sat back and reflected (30 hours of flying time to be exact). I had with me memories of looking into the eyes of 2 men who had aged gracefully, still full of life, without complaints, and thankful for who they were and for what they have.

They were garbage collectors in Ezbet, a “garbage city” in the slums of Cairo. Their whole life consists of collecting garbage, sorting it, living in it, eating it and sleeping in it. This is what they live for and that is all they know. And for that, they remain thankful. They make a living of about fifty cents a day if that, eat what they can find and live in a shelter made up of old burlap bags and cardboard boxes. They have been friends for over 50 years, and have no family other than each other. Partners, pals, brothers, soul mates. I spent several hours with them simply because I wanted to and more importantly because they made me smile. Despite their hardships, they had an outlook on life that is wanting in most of us: to be happy with what we have. Never once did either of them complain about their situation. Never once did either of them complain about who they were. Never once. But often, they shared their excitement in having another day to live with those who they loved and with God on their side.

I am ashamed to confess, that I challenged them on their attitude. How could they live like this? Why would they live like this? Why not go to the city and find a real job, get a real house, and live life? They in turn challenged me: what do you do with all your money? Where is your family and why aren’t they here with you? Why aren’t you smiling all the time? Why do you need to come here to see us in order to see yourself? What, I said to myself? “Why do you need to come here to see us in order to see yourself?” I stopped talking and listened. They had much to say and much to be said. I could do nothing else. Why did I need to go there to see them in order to see myself? Maybe it’s because without them, I see only that what I want to see and that which I’m told to see. I avoid all that is unpleasant, all that is blurry, all that is faded and look only at that which is focused and pleasant. Think about it. In the PICU we see awful things. But many times we look away or add anther layer of paint to the picture in order to hide the sadness. Have you ever look at a dying cancer patient, 12 years old, bald, weak, and pale, and wonder if that was you? Even if we are healthy, do other people see us like that? Weak and pale? It’s all in how we look at ourselves. And once we look at ourselves as being blessed and gifted with our talents, no matter what they may be (even garbage collecting), we feel like we are blessed and gifted. Those 2 old men did. I could see it. I am betting that you can too.

I find it curious that I had such a profound reaction to such a seemingly random encounter with these 2 men. These kind of heart-lifting experiences are few and far between and I hold on to them as close as I can. Some people say that the single most powerful argument against the reality of the love of God is the injustice that some people have when it comes to life. From where I stood, these 2 men got the short end of the stick. They don’t necessarily think so however. It is that very superficial lifestyle that I’ve become accustomed to, that stands in the way of seeing that there is at least some good in all that is handed us. For whatever reason, they made me think and realize my faults. I looked at myself and saw what I should have seen, not what I wanted to see. Simply put, when we talk about gifts, charity, and helping others, we should perhaps look at who we are or someone will do it for us.

In all things give thanks,


copyright 2006