Wednesday, July 26, 2006
I've known him for 10 years. We met on the beach after I watched him for a few days, talking to some unknown person out there in the ocean, waving his hands and bowing. He spent days alone, lying on a dirty blanket, always in the same place right at the edge of the sand where it met with the high tide. No one would sit next to him even when the beach was crowded. He wore the same clothes day in and day out, long hair matted, dirty finger nails, and drinking from a bottle in a paper bag. I found out later that the bottle was simply filled with water. I was intrigued by his actions, and embarrassed by the actions of others and myself: avoidance and distrust.
In the early evening, he would stand at the edge of the water, look west, lift his hat and bow, to nobody. He would raise his hands, wave, and make the shape of a heart in the air and I could hear him say "I love you" over and over again. He would stay there and do this until the sun went down behind the horizon, and with his head hung low, shuffle up the beach and disappear for the night. I was to find out who he was and to whom he was talking to.
I went up to him late one afternoon, introduced myself and asked if he would like some company. Without any hesitation, he said yes, and for the last 10 years, we have met and talked for hours almost every day of my time on the beach each summer. I saw him again last week. Hugh is 64 years old, has 2 master's degrees, taught poetry in college, and lived la vida loca high on LSD from the time he was 20 until he crashed at the age of 40. He has been homeless off and on (more on than off) ever since. His mind is burned with LSD, flashbacks are frequent, but during his lucid times, he is smart, gentle and humble. Those times are becoming fewer and fewer, and last week, it was obvious that he was getting worse; he couldn't remember where he taught, went to college, or when we saw each other last. He sleeps in a park off the beach. I took him to one of our favorite places, Prince of Peace Abbey. We attened mass, we prayed, and talked for several hours, looking at the ocean from atop a hill where the abbey is. I listened as he moved from one subject to the next, sometimes making sense, most of the time not. We talked about Joe. She is the person he talks to, who he sees on the ocean in the evening, his love, his life. He says she lives on a sailboat and stays in the marina near the beach. I've checked. She doesn't exist. I've told him so, only to see his eyes water up and he becomes quiet, and he goes on talking about her as if he didn't hear me. I don't bring it up anymore.
Last week when I dropped him off at the park, I hugged him, held his hands as we prayed, and felt comfortable being with him despite what he was: a homeless, wasted, lonely man. I have grown to love him for who he is: a brother who seeks only that to which he is entitled to - dignity and personhood. He is no different than the rest of us. We look to others for love and support, and welcome the warm embrace of those we love, the softness of a touch, the smell, the feel, the words, and the look they give us with their eyes. Hugh looks to Joe for all of that as well, raising his hat and waving his hands, making the shape of a heart with his hands to someone he loves out there in the ocean, wanting to feel her warmth. He believes in her. A fool's errand. But a sweet, gentle fool, who lives a life as a consequence of what he did to himself in the past. I look past that, and see in him, the "forgotten children" to whom we are committed...the innocent, abandoned, lonely, and forgotten children. Hugh...I think of you often and may you find "Joe" wherever she is.
In all things, give thanks...
Wednesday, July 12, 2006
I got an email from Daran Rehmeyer who is overseeing the building of the medical clinic in Mbabane. He included pictures of the beginning construction and since the pictures have been taken, the slab has been poured and the block walls are going up. By the time I get there in about 3 weeks, things should be moving along pretty rapidly. I just finished putting together the equipment and medicine list for the clinic. Pray that we can get all that we need and in time for the medical team's arrival in October. I'll keep you all posted. And as you look at the picture above, realize that it was only about 5 months ago that I visited Swaziland...He moves things forward quickly when it is in His favor and is pleasing to Him....
In all things, give thanks.
Tuesday, July 11, 2006
A 3 year old little girl was found in the parking lot of Mbabane Hospital a few months ago. She was placed in Ward 8, a ward for abandoned children (some of you have seen my pictures of the ward and have head the stories). She had been terribly sexually abused, physically torn, and had large genital warts that were painful. She is HIV positive as well. In her blog (http://rehmeyers.blogspot.com), Teresa describes her time with the little girl. See if you can get through it without breaking down...I couldn't.
We will be exposed to alot in October. Most of it will be good, exciting, and blessed. We will also be faced with evil at times. The children we will see have stories. The childen we will see have pain. But the children that we will see will also have been touched by the hands of Teresa and Daran and Ben and Dave, missionaries who spend their lives bringing His love to those "forgotten children".
I pray that we too will touch the lives of those children through our medical work: healing as we can, loving always...as His servants.
In all things, give thanks.
Saturday, July 08, 2006
Just 8 months ago, I traveled to Gaza the day after I was in Amman, Jordan. I was in Amman on the day that the hotels were bombed, and was just a few hundred yards away from them visiting with an American missionary who is a pediatrician working in the refugee camps in Jordan.
Getting into Gaza was difficult enough. Getting out left a little to be desired. I traveled with Peter Omran, the Project Manager for MOM for that area. Peter used to be a member of the PLO, Palestinian Liberation Front, who came to Christ, and left the PLO. There we were, Peter, an ex-PLO and me, a Messianic Jew (a Jewish believer), traveling to Gaza to see if we could get a medical team into the country to take care of hundreds of refugees. Here is what I saw and did:
We left Amman to go to Gaza via the road to the Dead Sea passing the Baptismal site for John the Baptist. We arrive at the boarder crossing only to find 1000 cars already lined up to get across into Jerusalem. We use our pull with American passports and get to the front of the line and realize that even with that we have a long wait. We decide to use a "VIP" service that for $82 a person will do all the paperwork, and move us through "no man's land" and get us through the Jerusalem side with assistance. It seems like a good idea. We pay a 5 JD departure tax to get out of Jordan. "No mans land” is simply that. A stretch of 5 kilometers that belongs to nobody but is protected by everybody. We go through no less that 4 checkpoints, see multiple bunkers and multiple armed sites. Our passports are checked at each check point. We arrive at King Hussein Bridge and cross the Jordan River. Into NML. We arrive on the Jerusalem side at the Allenby Bridge check point. Israel security is very thick and a lot of questions are asked. As we cross NML we see the city of Jericho and Mt. Temptation. Getting through from Jordan to Jerusalem takes us almost 8 hours with clear evidence of harassment and discrimination from the Israelis to the Jordanians. There is a bomb scare on the Israeli side and we are all told to stay put. There is tension everywhere. The Israeli undercover agents are not so undercover. They all carry AK47's in plain clothes and look like they are ready to use them. We arrive in Jerusalem and go to the Jerusalem Hotel for a late lunch and wait for John Carlock the AOG missionary from Gaza to meet us and to take us into Gaza. He and his wife have been there for about 2 years and are the only Americans in Gaza. They have 2 boys, 8 and 6 and a girl 2 years old. Their faith is very evident. They live in a walled in complex but feel safe being in Gaza. We get to the Gaza boarder and find the city surrounded by huge walls, like Berlin used to be years ago. We go through 3 more check points, passport control, and then we enter a bunkered tunnel that is a half mile long that we have to walk though carrying all of our stuff. The walls are riddled with bullets and there are cameras everywhere. We feel like we are entering a prison and we are. Gaza is a prison. No one can come in unless they are with the UN or are with an NGO. I sent my passport information weeks ago to John who got me clearance to enter Gaza as a member of AOG. No one can get out. Before the disengagement, 100,000 Palestinians from Gaza would go to work in Israel and return at night. Now they can’t. 99% of all Palestinians are unemployed. The Hammas rule the streets and the Palestinian authority rule the government, or what they think is the government. Before the disengagement there we about 6000 Israelis living in Gaza in 20% of the land and 1.4 million Palestinians were living in the other 80% of the land. Israeli spent billions of dollars trying to protect those Israelis and finally disengaged from Gaza, pulling out all the Israelis. That land now belongs to the PA Authority. There are multiple refugee camps in Gaza that house the Palestinians. Jabalia is one of them, and that is where we went.
The Gaza Lighthouse School is what John is responsible for. It is a school that is from 1st to 3rd grade and has 60 students from the refugee camps that are bussed in. It costs$40 a month to support a child and they have full sponsorship form the Baptist churches in the US. Of the 60 students only 1 is a Christian. The 3 teachers are Christians. MOM is trying to start an after school program for about 100 kids from the Zeitun area of Gaza. The school is very nice. It used to be a nursing school. The top 2 floors are not being used and can be easily turned into a medical clinic.
I noted that there is a lot of mental illness, depression, etc, and bed wetting in children because of the atrocities that the children have witnessed. The refugees are so poor that the children are kept from school to sell peanuts in the street which no one buys because there is no money to buy peanuts with.
The UN is very active with the refugees. The UN Relief Works Agency is responsible for having medical clinics for all refugees and I visited one which is fairly modest with doctors, but the care is suboptimal. Medicine is scarce.
I met with the administrator of the Ali Arab Hospital which began in 1882 as a CMS hospital from England then became a Baptist hospital in 1952. It is now under the Episcopalian diocese of Gaza. It serves as a base for foreign teams to do plastic and orthopedic surgery. Even though it is a Christian hospital only 10% of the staff are Christian. It has 80 beds of which only 50 are used because of funds. It is primarily a surgical hospital and is well equipped, albeit with old equipment. The average cost per bed per day is $98 none of which the patient pays. The hospital has a $600,000 deficit per year. It receives help from the UN and private donations.
We finally went to the Jabalia refugee project. I can't describe what it was like. The buildings are simply shells with as many as 10 people living in small room without heat or electricity. They do have water. We visited 5 families. We visited a small dwelling with 5 severely mentally incapacitated women living there under the care of an elderly woman who herself had cancer (I have pictures that describe it better than he words ever can). The poor and destitute are beyond hope. We were with 2 of the refugees who themselves began an organization to get food and goods to the poorest of the poor. It was quite a testimony to their love of humanity.
Gaza in short is a prison with walls, filled with people who have no hope, and children who are forgotten. Today, July 8, 2006, the Israeli army is now only 500 yards from Zeitun, the refugee camp that I wanted to take a medical team to. The war is heating up. Zeitun may fall. The refugees that we met are in hiding, unsure of what is going to happen next. And the "forgotten children" are hungry, alone, and scared. Medical Mercy. A medical team from Mission of Mercy, wanting to go, but can't. Maybe another time. Maybe in God's time. We'll be ready.
In all things, give thanks.
What follows is a very basic description of what a typical team would do, and how the clinics are set up.
To explain briefly, patients line up outside of the clinic usually quite early in the morning. The lines are then organized by specialty: medical, dental, optical. The patients are then registered with their name and address placed on the encounter card. They then proceed to the triage waiting line, followed by triage where a brief history and vitals are recorded. After triage patients are moved to the appropriate waiting line for the service they are presenting for. The patients then receive their exams and move to the spiritual counseling line, receive spiritual counseling and then wait for their medications at pharmacy. After pharmacy they are lead outside of the clinic to allow optimal flow.
The above schematic works great in a large sanctuary, school or hall utilizing string and curtains to make cubicles for the examiners or simply having enough space between examiners for a comfortable examination of the patients. We have conducted clinics in schools with classrooms and in villages in open and closed buildings and under huge tarps. Each of our clinics looks different, but all follow the flow pattern above. We have always been able to have a similar flow, regardless of the setting, though creativity is often required.
We limit patients to one service through the clinic at any given time as the lines waiting out front may not fairly get a chance at care if one patient is allowed to see medical, dental and optical in one pass. After a patient completes a pass through the clinic, they are welcome to join the line of their desired service if it’s not too long or return later on another day of clinic if we return there.
What we have found is that encounter cards that are numbered need to be given to registration little by little throughout the day or ideally before we arrive with careful attention paid to the flow of the clinic and any backlog in the pharmacy or counseling area. Numbers from 1-100 are used for a 2 hour block of time: 8am-10am, 10-noon, 1pm-3pm, 3pm-5pm. This limits the overwhelming numbers on the examiners, and keeps the crowds down. Depending on the number of examiners, we can either increase or decrease the numbers. 100 patients in 2 hours seem to work well with 3 examiners. We have asked local ministry helpers, the local pastors, and the missionaries to disperse the numbered cards so that they may follow up with those whom they have found to be in most need.
The triage nursing area provides a great function to supply a brief history and to check vitals signs on patients. Ideally there will be an automated blood pressure cuff to allow rapid assessments in a noisy environment. We find that two people staffing this area works best and one can be pulled aside to assist a physician in performing exams or checking a blood sugar, pregnancy or urine test. Documenting allergies and current medications greatly assists in the medical evaluation and enhances patient care safety. There are many times however when we have had to bypass the triage area and see patients directly due to the large numbers of people waiting to see the team.
Adequate seating areas should be arranged using chairs or benches to allow an orderly and comfortable flow for the patients who will be spending quite a while waiting for the various phases of the clinic. Adjustments may need to be made to add to or take away from the various lines of benches to accommodate the optimum flow. If at all possible, finding an area out of the elements for the usual long line of patients outside is ideal. The clinic should not be overrun, however, so in many locations it is just impossible to arrange this. In this area, we have found that local pastors and the missionaries can interact with the patients, introducing them to his word. Public health issues can be taught such as dental care, hygiene, and nutrition.
Since each examiner will move at a different pace, having one general waiting line is better than having individual lines for each examiner. This way, the next patient in line will be taken by the next available examiner.
Each examiner in an efficient medical mission clinic with minimal paperwork should be capable of seeing 50+ patients per day which is a pace of about 6+ patients per hour. That would be a minimum. There have been times when we have been able to see twice that number in an hour. A balance must be sought in the humanitarian need to examine as many people of the community as possible, with the need to provide quality care and an adequate presentation of Christian love and the Gospel message. If we are working in an area of large population we find that having the examiners stick to medical care and allowing the spiritual counselors to handle the Gospel presentation and counseling allows the greatest efficiency while still allowing the spiritual goal to be accomplished. In such a setting we would ask our examiner to pray that the Holy Spirit would guide them to knowing when they may be asked to initiate spiritual discussion as at times the examiner who touches the patient can provide the greatest witness for Christ. We pray that God would bring those to the clinic who need to be there as a mission clinic will always be a limited resource to a large population of needy people.
The dental clinic requires a location with good lighting. If a source of running water is available then situating the dentist near that area (if it allows for appropriate patient flow) is ideal. Also important is access to electricity if compressors are being used to allow drilling and cleanings. Portable generators may be necessary. Provision must be made to allow for sharps handling and disposal. A great system for sterilization can be made using a series of baths including soapy water, gluteraldehyde, clean rinse and then steam sterilization using a pressure cooker over a hot plate.
The optical clinic will also require an area with adequate lighting. Having tracts available or a Bible in the local language will allow the examiner to test the reading glasses on each patient. A small kit with needle and thread or similar can also allow testing for those who are illiterate.
Medical Mercy believes that spiritual counseling remains a number one priority. We would require a local church or group to commit to a follow up plan in order for us to agree to put on a clinic. Ideally the local church or churches participating will have their Pastor(s) present and actively counseling along with their best and most mature church leaders (deacon and deaconess type leaders). We would look to the missionaries for guidance on how best to proceed.
A pharmacist and assistants will set up, supply and distribute medications. It is imperative that traffic flow in and out of the pharmacy be kept to a minimum as this area tends to be a center of attraction and efficiency mandates the area be kept clear of extra non-essential staff or visitors.
In addition to the clinical staff, I would utilize a support staff utilizing local church volunteers and United States based volunteers. There are almost always more people who want to help than room to allow them. We would assign roles and possibly do so in shifts.
US based team:
Child Life Specialist: 1
Support lay staff: 2-5
Total team members: 10- 18
Pastors: dependent on location
Total team members: 8-10
Medications: enough to treat 1500 patients
Portable dental extraction and restoration equipment
Typical Medial Clinic setup:
Public health education
These teams are specific for a particular country in terms of medical needs and are lead by an experienced phyiscian, nurse, and lay person. New team members are always welcomed, and become an important part of who we are.
In all things, give thanks.
Thursday, July 06, 2006
I've been getting a lot of questions recently about who these "Forgotten Children" are that we are talking about. Mission of Mercy has a unique vision for a specific group of children who have largely been "forgotten" by other child sponsorship organizations:
-Children impacted by armed conflict
-Children impacted by HIV/AIDS
-Victims of child trafficking
-Children under five struggling for survival
These are children who barely survive in the midst of extremely difficult circumstances. Every day, forgotten children are exposed to multiple threats to their physical and mental well-being. Forgotten children grow up without access to proper adult care and attention. Their lives are led outside of the protection normally extended to the young and vulnerable.
We have seen these children on our trips to Cambodia and my trips to Jordan, Gaza, Ethiopia, Egypt, and Swaziland. Their faces are all the same. Their smiles contagious. Their plight is evident.
What "Medical Mercy" is doing, is bringing health care to them through our trips and medical clinics, ensuring that their health is maintained, giving them the opportunity to grow up in a loving God- filled environement through the work of the missionairies we partner with.
In all things, give thanks.
Saturday, July 01, 2006
He died last night. Steven was 17 years old, had leukemia, and struggled with life for several weeks while in the intensive care unit. He and I had a fairly good relationship, sharing stories and simple hellos. His mother is who I couldn't relate to. She was angry, obstructive, abusive, and confrontational. And she was a Christian. She had incredible faith but little tolerance for reality. As a Christian I tried on many occaisons to try and see past her faults and the way she treated us. I wanted to simply put my arms around her, pray with her, share scripture with her, and pray with Steven. She wouldn't let it happen. Her character and her demeanor prevented it. Or so I thought. Once again, my pride and ego prevented me from looking past "what" she was and really seeing "who" she was: a mother hurting as her son died.
As we prepare for our medical trips, we will be faced with those countries who hate us, who don't want us there. It is that very obstruction that we must look past, with Christ in our hearts, accepting the slap and "turning the other cheek". I could have done that with Steven's mother but chose not to. When we feel there is nothing more we can do, look to see if it is really true. It may simply be because we chose not to do anything more. And that is where we need Him in our lives to guide us forward.
In all things, give thanks.