India Clinic day 6

What is done, is done. 1460 patients seen, 99% of them children, travelled to 4 different projects, diagnosed, treated and gave out medications to all of them, and we’re done. But interestingly enough, we are asking for more. We leave tonight to come back home, and few if any of us, are anxious to leave all the children we saw and cared for. Yes, we are anxious to return to our families, our homes, and our lives that are so different than what we saw here. It is the time we spent with the children that gave us the drive, to crusade, to try and makes their lives better by getting them healthy enough and to feel strong enough to get up in the morning and face their day of poverty. So, were we successful? In the book “Covenant Medicine: Being Present When P:resent”, I write about the four actions that we need to take when we establish a relationship with our patients: action (how will we change and improve our relationship with our patients), listening (listen to our patients silently), intentionality (focus on the patient, purposefully and willingly), and commitment (treat patients with dignity). Simply put, be present when present. We did all of that. As I watched the 22 members of the team rally forth, doing all four of those aspects of caring, I was wonderfully awed at their unselfish giving of themselves. And the children…I was wonderfully awed at how they came to us, neither of us being able to speak each others language, courageously, openly and with trust that only is seen when an unspoken covenant relationship is established. 

I thank the US team members and the India team members for all that they have done. “Being present when present. What a wonderful way to practice medicine.”

In all things give thanks,

David

India Medical Mercy clinic day 5

The smile is what caught my eye. Bright, genuine and confident...as long as she had her scarf on. I hadn't seen what was below the scarf, but did think it unusual for a young girl to be wearing one. There had to be something. The bald patches told it all.

I examined her as she came towards me. Her clothes were of average quality, she stood barely 4 feet tall, and her smile paraded before her. Sitting across from me, she continued to smile until I asked her if it would be okay for me to look at her scalp. She mumbled and the warm smile turned to a frown, her eyes diverted to the ground and she became uncomfortable. I looked at her scalp and then scrolled through WebMD, skimming over the details of the type of balding it couldn't be. I shut down the tablet staring straight ahead pondering the consequences of what I was going to say. Smiling, hopefully in an attitude of assurance and without judgement, I had made a diagnosis. Not the one that would yield the best result and a smile from her, but one that was going to cement her fears. What mattered was that her situation was a worst-case scenario that could play itself out later in her life.

This all started when she was about 5 or 6 years old. She is now 12. Her hair fell out in clumps and had been that way for years with no effective therapy that she tried. This is alopecia areata which may be reversible with hydrocortisone, but no guarantee. I gave her a bunch of tubes of it. So why you ask, am I sharing this with you? Because you need to know that because of where you live and because of what you have, you'll never find yourself where she will find herself when she gets older.

I asked her if I could take her picture. This is a sensitive issue, balancing her dignity and telling her story so that others can learn. I struggled with the decision and eventually felt that she would understand. In just a few short minutes we had a covenant relationship, trusting me to do my best to help her.

You need to know that because of her baldness she may never marry, be stigmatized and marginalized, or worse yet, she may marry a much older man who cares nothing about her or for her. A forced marriage. The simple truth is that a dysfunctional society makes up rules as it goes along, blindly hurting many because no one is interested in making things right.

I am trying to be careful in keeping this non controversial. So you ask, what is the lesson here, the learning point, the reason for this blog post? It's this: we are lucky for who we are, for what we have and for where we live. What we have is better than good. For many here in India, what they have is worse than bad. For this young girl, I wonder what life will bring her. I hope that it will bring at least some good. Her smile will not allow anything less.

In all things, give thanks,

David

India Medical Mercy clinic day 4

Oh, happy days! I saw her staring at me and wondered what her story was. I was in an administrative mode, meeting with the school pastor, talking to a missionary from Kentucky, and making notes for the report that I eventually would have to write. Others were tending to patients, and I to my paper and pen. But I kept looking at her as she made her way slowly forward in line to be seen and she kept looking at me. I knew there was a story there, a tap on the shoulder of "take notice" because "I have something to tell you." I couldn't resist. Getting up, I pulled her out of line and took her aside and with an interpreter asked a simple question, "tell me a little about yourself." And there it was. The story.

She is 6 years old or there about, living a life that she described as "happy." No prompting from me. She goes to school, loves her family, wants to be a "Doctor" (okay, I pushed her in that direction a little bit) and loves to eat. No complaints, life is good, happy days ahead. Go figure. After yesterday, this was a breath of fresh air that needed hand clapping, hugs and a little dance of joy. How wonderful to see the good side, and an attitude of acceptance for what little is given us.

I hugged her and put her back in line, walked away, singing a tune...oh happy days!

In all things give thanks,

David

India Medical Mercy clinic day 3

Where does it hurt?

I noticed her right away. She was sitting in a row of children but she wasn't really there. Her eyes were distant, her affect depressed and her face showed a distant picture of a difficult life. As I examined children, one right after another, I wondered if the odds would be for her to come to me. I counted off the children sitting in the row, watched the other doctors and nurses who were examining children, counting off as they finished, still wondering if she would be my next patient. She was.

"How are you feeling?" I asked looking at her drawn face. She didn't reply.

"Does anything hurt?" I tried again.

The answer I got back was what I was hoping not to hear. For some reason it was clear why she looked the way she did, and for some reason I knew why. And I didn't want to hear it. Her wide eyes gave some of it away, her affect confirming it. She hadn't eaten dinner last night, nor lunch, and this afternoon, had had only a small glass of milk. They had no food. She lived with her mother, her older brother, and her grandmother. Her father had traveled to New Delhi to find work and to send money back. He was a farmer but his land had been taken away by the government in order to build a building. And you ask, how can that be? It is what it is.

This community is poor, even more than poor. When I asked "does anything hurt", she had no answer because after a certain point in time without food, it doesn't hurt anymore. She was one of the community children we saw after we saw all of our OCM sponsored children. I wonder how many more like her there are.

I sat back and thought for a minute just what this all means. We've all asked this question before of God: why do You let things like this happen? And I for one, have never gotten an answer. We are on our 3rd day of clinics and have seen more than I can ever write about and have more questions for God that are queued up waiting for answers. What I do know is that when I ask the question "where does it hurt", I find myself answering my own question: "my heart hurts."

You would think we would give her money to buy food or even give her some food if we had some. But there is some danger in that. Being singled out in a community that is impoverished brings animosity and jealously. We could put her and her family in great harm. So the best that we could do was to explore ways to feed the whole community. Not so easily done.

I asked her if I could take her picture and she said yes. I tried to show it to her, but she looked away. I wonder why. She went on her way, with some prayer and some vitamins and as I watched her leave our makeshift medical clinic, my heart hurt. These are the hard times we face when we come to serve and these are the times that I ask the hard questions of God waiting for an answer. God, I'm listening.

In all things give thanks,

David

India Medical Mercy clinic day 2

Do they fit?

It seems that in life we are sometimes given tasks that we just can't put our arms around and are given shoes that just don't fit. But we do the tasks and if we have no other shoes, we squeeze into those given us. I wonder if there is a lesson here.

He was about 12 years old, head held high, no lack of confidence and a character that guaranteed he was capable of anything. I looked at his eyes as they bore right into mine, eyes that questioned the relationship and its purpose.

"How can I help you?" I asked, looking at the grimace in his face that was appearing slowly. He was rubbing his shins.

There was an awkward silence as he waited for the translation of my question and then he simply said, "my legs hurt."

I looked down and saw his shoes. Too small with the fronts cut out to make way for the big toe that was ready to go out and explore the world. His legs hurt. Not his feet, not his shoes are too small, and not can you give me a bigger pair. He was okay with what he had.

We came to India to serve and give, humbly and with grace. I sat before a young boy who felt no shame in wearing shoes too small with his toes bursting through and wondered how vain we are when we look in the mirror and see that our pants are a little tight or the dress doesn't fit that well anymore. We take them off and put them aside and maybe pass them on to the Good Will.

I witnessed true acceptance of what had been given this young boy, no questions asked, no remorse, no embarrassment and no asking for something better. He had what he had, what life and I believe what God had placed in his life and he took on the task, wore his shoes and moved forward not wanting more. So you see, the shoes didn't look like they fit to me, but to him, they fit just fine. And that's what our God wants of us: we may not think we fit the task given us, but He does. The shoes always fit if we want them to. They bring a little discomfort, but maybe there is a reason and if we look hard enough and listen close enough, we'll understand His commands.

As for me, I need to loosen my belt a notch or two. Or maybe I don't. God is telling me to lose a little weight I think.

India Clinic Day 1: Two of a kind

He came over slowly, his eyes looking off to one side. Sitting, he placed his hands in his lap, sat forward and looked everywhere but at me. He was 12 years old but was the size of a 6 year old. Stunted and malnourished, he was shy, introverted and clearly uncomfortable. Taking his hand, I held it for a moment saying nothing, and then I simply looked at hm and smiled. He turned and looked at me and a faint smile appeared if only for a moment. I asked if I could take his picture so as to remember his smile and he smiled just a little bit more. But his eyes said it all. Do you see it? Sadness, with just a touch of hope. But we connected. A relationship of trust, that unspoken covenant, that singular moment of understanding between 2 people spoken without words.
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He came over slowly, feet shuffling, a look of wonder and uncertainty as to what this was all about. His was a slightly cherubic face, a child of only 4 years old with a no nonsense character and an attitude that begged for an invitation to engage but only on his terms. And I did. I took his hand and held it for a moment. He took his hand away and held it close to his lap. He wanted no part of this relationship that I was trying hard to establish. I tried again, but there was no chance of winning him over. He was healthy, well nourished and sure of himself.
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And so I wondered, how different and yet how much they were the same. Both born into the same community, same exposure to hardships, and the same opportunities given to them granted they were limited and minimal. One was stunted, malnourished, small for age and destined for a life of poor health and poverty as a result. The other was just a little fatty with an attitude of "I can do anything", destined to a life that would lead him to a better place. Two of a kind. Interesting how relationships are more often grounded between those who are fragile and those who are wanting to give. That came home to me today. Two of a kind, but not really.

In all things give thanks,

David

India: Getting here

After 36+ hours we've arrived. Flying you would think is tedious, but while flying we are detached and remotely singular for hours and for many miles, over 11,000 miles in fact. This solitude comes rarely these days in our busy world. We have time to reflect, ponder, dream and drift off without having to worry about the inevitable interruptions, requests, emails, texts or banter that our lives are so often burdened with. So reflect I did and prepared my heart and mind for the five days of clinics that we will be holding in remote projects and villages. There is no story here other than to say that sometimes we need to get to 38,000 feet, find some quiet time, and reminder selves that there is someone greater than ourselves who puts us in places where we may not think we belong but are needed all the same. And yes, this time it's India.

We have a free day tomorrow which is unusual in order to get us well rested for the marathon that will begin on Monday. I'll be back then with stories to tell and a look see at a part of the world where children struggle and are sometimes forgotten.

In all things give thanks,

David

India: I'm ready!

So “Father Time”, guess what? There is nothing, nothing, that can stop me now! I’m ready! I’ve prayed, packed, prayed, paid the bills, prayed, gave my last lectures, prayed, did some clinical time in the PICU and then prayed some more. And I’m ready!

 

Now let me ask you something “Father Time”? Are you ready? Are you ready to keep us on schedule, to make sure all the flights make it out on time, that we make all the connections, that we wake up on time on the first day of clinic after flying for 36 hours and with jet lag, to get the children we are going to see to the projects on time, to give us room to maneuver the big bus we will be in through the traffic in India (you’ve seen the traffic in India haven’t you?), and to make sure that we find time for rest somewhere in the night when it is dark and all but us are asleep? I hope you are, because I am counting on you.

 

Amen… and in all things give thanks,

 

David

India: Am I ready?

“Father time” just tapped me on the shoulder. “Are you ready to go?” he said. I didn’t reply. “Are you ready to go?” he said, this time enunciating each word, each louder than the next and each with a pause in between them. “No, I’m not” I softly said. It was a foolish question that deserved no answer or an answer that was simply an honest one. Who is ever ready for what we are about to do? Sure, we’re ready with the flight reservations, the medications that are all packed, the clusters of clothes and “stuff” that we each need to pack, and our music and reading material. But I for one am not ready, not mentally ready, not spiritually ready and not emotionally ready. How can that be? It is what it is. How do we get ready for the things that we will see, that we will experience and the people and children who will come to us for help? How do we get ready to enter into a world so unlike our own, a world of severe poverty, sadness, hunger, illness and want? We (Medical Mercy) leave in 1  week for India. A country of slums and waste, burdened by a mass of people who have little chance of finding any meaningful space of their own. We’ve been there before, have lived it, and now we are going back for more. Am I ready? Not even. We have a team of 24 servants, who are giving of themselves to do this. So for the next  week, I’ll get ready by praying. It is what I do before each trip. Prayer for me gets me ready for whatever is waiting out there. I’ll find solace in the fact that there will be someone who will be in charge, someone who will carry the torch, and someone who will lead the way. I just need to follow. That someone is the same someone I pray to. You know who He is. So, “Father time”, ask me again in 1 week if I’m ready. I think you’ll like my answer.

 

In all things give thanks,

 

David

Cambodia Clinic Day 5 and wrap up

Hands on the shoulder of the one in front of them, they moved in a line through nutritional assessment then waited to be seen by a medical provider. Each had a different expression, some smiling, some not so sure of what to expect, some showing nervousness, some taking everything in and some just looked like they had been through this before. I remember one little boy in particular. He was shy, eyes downcast, hands twisting inside of each other, and feet moving from side to side. I watched him as he went to get weighed and then measured for height. He never looked up, obeyed instructions and moved from one station to another. One always questions coincidences or at least I do. Out of the 15 medical examiners, the hundreds of children we were seeing, the line moving at a pace that resembled a quiet chaos of order, he was brought to me. Coincidence, I think not. He sat down in front of me, eyes diverted, ignoring my smiles, my hand on his, and my gentle assurance that all will be well. Sitting back, I looked at him and stayed silent for a moment. I did not have an interpreter, so I took a chance.

 

“Do you know who I am?” I asked in English. He did not reply.

 

“Do you know why you are here?” He didn’t look up. I thought how silly of me to expect him to understand English and to respond. I tried another approach.

 

“Can I hold your hand? Will you let me listen to your heart?” He looked up making contact with my eyes. He reached out his hand. I took it. We sat like that for a few moments, not saying anything. I held his hand and smiled. And he smiled back. I leaned in and put my stethoscope on his chest and I heard his heart beating fast, and as I listened some more holding his hand, I heard his heart beat slow, his breathing more regular and his hand resting comfortably in mine.

 

I asked an interpreter sitting at another table to ask this little boy if he spoke English. The little boy when asked shook his head no. He smiled at me, and reached out for both of my hands now and held tight. I held tight too and then asked him if I could finish examining him. He said nothing but let go of my hands. I finished examining him, the whole time of which he look at me and smiled.

 

When I was done, I filled out his form, gave him his plastic bag that he would use to get his vitamins, his tooth brush, a small gift, stickers, and an antibiotic I prescribed for his ear infection. He stood, started to walk away then stopped. He turned, looked at me and smiled. I smiled back. I watched him for a long time as he made his way in the line through all the rest of the stations. As he came to the last one, he turned around again and smiled at me one more time. I smiled back. He was 5 years old. How did all this happen? Did he understand English? I’ll never know. But all that is a never mind. I remember what I told the team the first day about expectations and that it is all about what we leave behind. I’ll never forget him, and I hope he never forgets me. I have no reason to try and figure this whole thing out, to dwell on the whys and the how’s, because for me the expectation on this trip was that I would see God’s hand touch those who we came to see and I did. I believe that He gave that child a listening heart that understood me and He gave me a patient heart to trust that He would be there for all of us. I saw it all during the week. A team of 31 servants who had listening and patient hearts, giving of themselves to the 1500 children who we saw this week.

 

Until our next trip in October to India, in all things give thanks,

 

David

Cambodia Clinic Day 4

So help me out here. Another day at a school, hundreds of children seen, most with an illness or 2 overworking our pharmacy with dispensing medications. We are working in tandem and moving at a quick pace, seeing 220 children in about 2.5 hours. Do the math and you’ll get an idea of how we did in a 6 hour clinic day (okay I’ll tell you…534 children seen today). But that is not what I need help with. This morning I gave a talk on child abuse, one of the several clinical pearls I do each morning while we are on a medical mission trip. We talked about presentation, suspicion of, treatment of and protection of the child. We also talked about the cultural differences when it comes to parenting and what we consider child abuse. Do we impose our cultural standards of child protection on other cultures or do we try to understand the other side and look the other way when a child is being hit with a stick which they consider accepted discipline? What about the medical side? “Coining” is when a coin is rubbed hard on the skin making significant red streaks over the back and the chest. Purpose? To rid the child of fever and bad humors and is common here. But what about something more disturbing. Placing a burning ember on the skin in a pattern described by a local medicine man to rid the body of, again, bad humors? And on a child. Held down and burned. We saw such a child today. The picture clearly shows the scar of the burn mark. When the Cambodians who were working with us were asked about it, there was a shrug of the shoulder and a general acceptance that is a cultural norm. Not so with us. We struggled with it and wondered how we could teach the sensitive and true side of caring without harming the child. The answer wasn’t simple. They don’t see it as harmful, but truly a caring nature to help cure their child of disease. A parent’s love, genuine no different than our own desire to protect our children from illness, but to us incomprehensible as to how they did so. So, we shook our heads, and hoped that some insight to what child abuse is would cross all cultural boundaries one day. What say you? Other than that, we had a wonderful day…

 

In all things give thanks,

 

David