Bullet Wound

      This young man from the Horn of Africa is trying to close his mouth.  But it fixated in this position.  He was riding in a bus back home a week previous when he was hijacked.  Gunshots were heard and he tried to duck but it was too late.  A bullet entered his right cheek and proceed through his right mandible, into the floor of the mouth, into the left mandible, and then out the left cheek.  

        You can see the shattered aftermath and defects of his mandible after this type of trauma.   The patient was very matter-of-fact about this type of violence, neither scared nor surprised about how or where this shooting happened.  As you can imagine if the bullet had entered his brain, brain stem, or neck he would likely be dead or paralyzed.   

Kissing

Not sure who first decided to see if they could kiss a giraffe, but we were encouraged to try it. All I can say is it's like taking a loofa sponge to your face, but instead of leaving your face smooth it's left really wet!  

Sharon and David's wedding

Sharon looked stunning coming down the aisle as I played Liszt Consolation no.3. David eagerly waited and they looked glowingly at each other the entire length of the Anglican service. The setting was at the base of Mount Kenya on a private game preserve and while traveling from the accommodations to the wedding lawn elephants, gazelle and giraffe were all spotted. Mt Kenya made an appearance which is incredible rare for May. (It was also incredibly rare to be attending a wedding on a Wednesday.) And we crossed the equator no less than 10 times driving to and from the reserve. It was a joy to be part of their celebration of marriage. Stephany, Sharon and I have done something together one night a week since August. We have become a sort of support group for each other. When the happy couple returns from their honeymoon in Zanzibar, we will only have one more chance for our weekly "meeting." And I will be losing my colleague. I admit that amongst all the celebration I couldn't ignore that loss and my tears were both of joy and sadness.  

When Can You Throw In the Towel?

When can you leave a job or a ministry? Are there areas that are not ripe for the harvest? What are legitimate reasons for "throwing in the towel"? Did Jesus ever give his disciples permission to simply move on? And how can we know what those reasons are?

The 10/40 Window has been one of the most successful and convenient marketing missionaries tools in the last 10 years. Who hasn’t seen a map of the 10/40 window? Guthrie in "Missions in the Third Millenium" writes:

The 10/40 window is an imaginary box drawn between 10 and 40 degrees of longitude, encompassing parts or all of 62 countries in Africa and Asia and a bit of Europe.... Some 3.1 billion people, approximately half of the worlds population live in the Window... This area is the epicenter to Islam, Hinduism, and Buddhism. 82 percent of the world’s poor live here. 29 of the 62 countries that have the lowest quality of life based on life expectancy, infant mortality, and literacy reside in the Window.

Despite the apparent emphasis on the 10/40 window...only 3 percent of the global missionary force is there and 0.01 percent of Christian ministry funds go here (We aren't there either, Kenya is south of the Window). That all makes me feel sad and guilty..like the Church has really misdirected many of its resources or that maybe we have been unwilling to go where we are needed most. Where it is hot, ruled by law of another religion, and potentially unstable.

I wonder what God would think about how our resources have been spread? Would God want a missionary to remain in an unreached area for several decades with no openness to the Gospel (but maybe seeds are planted)? Does God want more missionaries going to areas like Latin America where evangelical and protestant churches are exploding (but many of these populations have multiple chances to hear the Gospel in a meaningful way)? Does God need more ministers in Europe and in the City where churches are empty and Christianity is dwindling? Isn’t it just a matter of going where the most need is (when you lift a heavy log you go to the end where no one else lifts)? Can we distill the Great Commission down to a geographic window and some telling statistics?

I don’t know who can answer these questions. But I do think God would be saddened that there is still so much poverty, illiteracy, rape, hunger, violence, corruption, and despair in the Window. Also one wonders is the despair in the Window because these areas have not been reached by the transforming power of the Gospel?

Missions needs to go to these areas. But I don’t think guilt is the right response to get people there, or the right response if they go and do not stay. When Jesus sent out the 12 disciples he gave them few instructions (bring nothing but a staff and wear sandals). Jesus might tell his 12 disciples where to go, when to begin, how many people should go together, what should be preached, what activities to involve themselves, or even ultimately what was their purpose. But Jesus didn't tell them any of these things. Jesus gave them this final command.

And if any place will not welcome you or listen to you,
shake the dust off your feet when you
leave, as a testimony against them (Mark 12).

Jesus compels James, John, Peter, and so forth that if they are 1) not welcome or 2) not listened to they should leave. If you have come and spoken, but are not wanted or not heard... Jesus tells you to walk away. Am I suggesting we shake the dust off our feet at the 10/40 window, our churches, our jobs, our communities. Of course not. Blessed are the persecuted. His followers will be hard-pressed and afflicted. No, these places need determined missionaries, pastors, relief agencies, neighbors, friends. God's light needs to shine. They need His grace. But we must also reserve the permission and courage to leave when we are not welcome or heard; and then follow His will elsewhere.

Samaritan's Purse Today

News updates and blogs about how God is working through Samaritan's Purse and around the world.

Physical & Spiritual Healing (friess family--May 21, 2010)

http://www.samaritanspurse.org/index.php/Samaritans_Purse_Today/

3 Awesome Minutes

In case you are not a soccer fan; you may not have know that for the first time ever the continent of Africa will host the 2010 FIFA world cup. 32 teams including the likes of Nigeria, Cameroon, & Ghana will be converging in South Africa to compete for the World Cup Trophy. Africa goes mad for soccer and I am looking forward to being in Kenya when it happens.

Unfortunately no teams from East Africa (Kenya, Uganda, Tanzania) are represented. But I will be proudly cheering on the USA squad as they take on England in their first match June 12th. Being just a few countries geographically away from SA (tanzania, zambia, zimbabwe) it was tempting to get tickets. But it didn't happen. Anybody out there got an extra ticket to the World Cup?

Check out this three minute anthem to the 2010 World Cup...even if you don't know soccer superstars like Rooney, Ronaldo, and Landon Donovan you will recognize Homer Simpson and Kobe Bryant.

http://www.youtube.com/watch?v=idLG6jh23yE&feature=player_embedded

If this can't get you excited about the worlds most popular game futball, then nothing can.

Are Physical & Spiritual Healing Inseparable?

In 1974 the Lausanne Congress on World Evangelization declared, "We affirm that evangelism and socio-political involvement are both part of our Christian duty," thus emphasizing social ministry as an important part of missions.

Many Christians now stress Holistic ministry; that is evangelism and physical/social care go hand in hand. We encourage the connection of spiritual and physical, loving each other and sharing the good news, soup kitchens and proclaiming God's glory, health care for the needy and advancing the Kingdom of God. Franklin Graham has said, "Holistic ministry (Medical Missions) just plain works."

But the idea of holistic ministry was introduced far before this declaration in 1974. Luke 4:18-19 explains what Jesus was sent to do:

to preach good news to the poor.
He has sent me to proclaim freedom for the prisoners
and recovery of sight for the blind,
to release the oppressed.

Some say this (preaching, setting captives free, healing, and standing up for the oppressed) should be the goal of the church and the main thrust of missions (note; preaching the good news is included). Others stress that the Great Commission in Matthew 28 should be our thrust:

Therefore go and make disciples of all nations, baptizing them in
the name of the Father and of the Son and of the Holy Spirit, and
teaching them to obey everything I have commanded you.


That is (discipleship, baptizing, and teaching the Gospel) is our mission. In the history of Christianity we have seen the pendulum swing back and forth. Some time it leans too far towards social action (let's give food to the hungry healthcare to the sick, and fight for the oppressed but let's avoid words like Jesus or God's love; those terms are too loaded and controversial these days). Then the pendulum can tip too far in the other direction (The Bible tells us we will always have the poor with us. We can't get distracted by this world, we must focus on the next Kingdom. We just need more churches, more preachers, and more getting people saved.) These extremes are easy to recognize, but in real life I think missions and the role of the church is more subtle.

See how DeYoung writes:

When you love, you love the whole person, right? So why do so many churches seem disinterested in the human problems in their community and around the world? Didn’t Jesus heal the sick? Didn’t the Good Samaritan help the beaten man just because it was the neighborly thing to do? He didn’t give him a gospel tract first. Look, I’m in a city with crime, homelessness, poverty, broken families, and a failing education system. If we love God and we love people, how can we not care about these problems? Yes, I want to see people come to know Christ. People need the gospel more than anything else. Hell is real. They need reconciliation with God above all else. But they also need food and a job. Christians should care about these needs too. We are supposed to seek the peace of the city. Therefore, our vision needs to be bigger than providing a safe church for middle class people to have a safe experience of God so they can drive back to their safe neighborhoods and ignore a world of problems around them. The Bible has too much to say about loving the poor and caring about justice for us to simply save souls. Heaven is not a place for ghosts to fly around. It’s an earthly place with resurrected bodies where matter matters. We don’t reflect the reality of heaven if we turn a blind eye to the flesh-and-blood world in which we live.

and to the other direction:

Yes, we agree that the Christians should love people in word and deed. We too want to see our communities flourish. We think it is good and right to support relief work in Haiti or build an orphanage in Africa or repair a park in our city. But we are jealous not to lose or de-emphasize in any way what makes the church unique. The goal is not to make the world honor us for our good works, but honor God in their hearts. There are any number of institutions or humanitarian organizations or even members of other religions devoted to the problems of poverty and suffering. But what about eternal suffering? Who will give the perishing the words of life except the church? If we truly love people we will share the gospel and disciple them in Christ. Of course we want the peace of the city. Who wouldn’t? But biblical shalom is not simply human flourishing, it is also, and irreducibly, faith and repentance. There is no kingdom without worship of the King. Besides, we aren’t going to change the world or transform the culture, at least not by our efforts and strategies. It’s too complicated and we’re too ignorant. Only God builds the kingdom. The church is not the custodian of the culture. The church’s role is to be the church. This means preaching and sacraments, discipline and membership, and displaying a counter-cultural community. We’ll influence the world, but do so as we live our regular lives, pursue our specific vocation, and love the people as God puts in our path. So absolutely I want to help people. But the church can only do so many things. And the main thing we must do is testify to the work of Christ and raise up disciples of Christ.

The current trend is that churches and denominations are pulling a way from medical missions (a holistic ministry). Medical missions has been accused of forgetting the spiritual component of healing (we would say they are intrinsically linked). But I think sometimes they are right. We can get so wrapped up in medicine that we forget the main thing. You can see a lot of prescriptions, surgeries, and clinic visits at a mission hospital and sometimes very little open Bibles, praying, or preaching. There are many mission hospitals that have taken a slow decline to becoming just another hospital.

Is this lack of spiritual ministry intentional by missionary doctors and the hospital staff? Are they nominal Christians? I don't think so. Some aren't good multitaskers (I'm not good at taking a sexual history and transitioning into prayer). Some find it awkward (while we straighten your teeth lets straighten your walk with the Lord). Some are just too plain busy (with a Queue of 50 patients, a lecture to give, and hysterectomy on schedule.... trying to explain Salvation in another language is the last thing I have time for) . And language and culture are real barriers to sharing (even after being in Kenya over 19 months).

My observations are still optimistic. I see that holistic ministry is happening here at mission hospitals in Kenya (hospital wide but perhaps not doctor specific). The doctor may do the life saving surgery... and the chaplain is present to see a life reconciled by Jesus. A team approach: physical and spiritual healing inseparable.

Unfair

Have you ever seen a cuter girl than this (besides your own children)? Mom came to see us wanting to know if we could do anything to fix her smile.



Yikes! This is the same girl above. This is what Fluorosis can do to the teeth of the children here in Kenya. Excess fluoride in the water causes the staining and pitting of teeth as well as skeletal malformations in the legs. It is not her fault, she simply grew up in Nakuru where the water has naturally over 11 times the therapeutic amount of fluoride. It always makes me feel life is unfair.

I did find out from our missionary friends in Nakuru that there is a Catholic charity that makes fluoride filtration systems using crushed bone that are relative cheap (15 dollars) and last for years.

Scenes Around Kijabe Hospital

The black spots on the wall are Locusts that have invaded the hospital. They are attracted to light and it is really not possible in this environment to close all the outside windows. Fresh air is a necessity in the Wards. I'll just leave it at that.



We have been drenched with rain at Kijabe. God has opened the clouds like not seen in the last decade. It has made the process of converting the operating rooms a little difficult. This is the storage area... or perhaps where operating room tables go to die.




I call these guys the Kijabe Thrashers (sounds like a good name for a horror flick). But I always wondered why the hospital would not buy them a lawn mover or weed eater. Them someone said, "of course the hospital could buy a lawn mover..but then the Thrashers would not have job." So they keep thrashing away all month long until the weeds are shoulder high once again.



Then I found out many of the Thrashers are not paid at all by the hospital. They bag the grass and sell it has Cow Feed.

Meredith & Friend

This is really not her friend, but I figure I ought to write down a few of Meredith's funny phrases before she stops saying them and they are lost forever.

"How come when I get out of the shower, the air is all froggy out."

"Mommy, can we have chips and Brocomole?"

"I want to go to Naiwobi."

"When we go on Nafari, can we see the flamangoes."

she sings--
"Where is beautiful Mommy?
There she is.
God loves beautiful Mommy.
I do to. I do to."

The best breakfast ever!

We were delighted to be invited to Giraffe Manor for breakfast. 

Their exclusive accommodations are the only location in the world to come-up close and personnel with the Rothschild Giraffe. It was such a treat to enjoy this breakfast and then be near the giraffes.

Particularly as this breakfast was a trial run of their new menu and therefore free of charge. It truly was a once in a lifetime event. Meredith and Amelia quickly overcame their fears and fed the giraffes for over 1 hour. While there were so many wonderful moments, the funniest moment was when I took Meredith to the restroom (keep in mind it is 880 dollars per night to stay here). She walked in and promptly said with genuine surprise, "Mommy it doesn't smell in here." I'm so glad she appreciates a clean toilet and restroom! And I'm not sure she would've learned this had we not lived in Kenya

A note of gratitude

Its not often in medicine that you find an encouraging note....

Dear Sir/Madam,

 

My name is M. from Mombasa Kenya.My wife S. was operated on at your premises in May 2010 for uterine fibroids.She was admitted and released.Her suregon was Dr.Sarah assisted by Dr.Sharon both of whom dis an excellent neat humane job and were ever ready to answer our questions.I was also very happy with the standard of care showed by your nurses among them the ever smiling Lucy,The efficent Josephine and others.Also to mention John of kitchen department who served very good food.

The hospital was also very clean and staff courteous and helpful.I would definetly recommend AIC Kijabe Hospital to my family,friends,colleagues.

 

Drs.Sarah & Sharon please accept my heart-felt thanks for curing my weife with God`s Help.May the healing of your hands continue to help many more people.

 

With Sincere Gratitude

 

M.

Endodontic Referral

      This is interesting to me (may be quite boring to others) but I know a few dentists log on here from time to time.  This man was referred to our clinic with these x-rays in hand wanting to know if we could "guarantee" that we could save his 2nd Molar.

    Mesial and distal canals seem straight but canal space disappears as you move apically.  You can see a distal apical RL.  Distal canal was accessed by previous dentist and filed to near WL.

Oooops. Hand file perforation into the furcation by previous dentist when searching for mesial canals.  But recognized and patient was appropriately counseled.  

   Perforation repaired with amalgam.  Still unable to gain access to mesial canals.  To answer the patient's original questions (Can it be saved).... no guarantees were made, except our best effort.

Kijabe Matatu Service

      Amelia is the driver and Meredith the captain.  

Locusts

And the LORD said to Moses, "Stretch out your hand over Egypt so that locusts will swarm over the land and devour everything growing in the fields, everything left by the hail."  So Moses stretched out his staff over Egypt, and the LORD made an east wind blow across the land all that day and all that night. By morning the wind had brought the locusts; they invaded all Egypt and settled down in every area of the country in great numbers. Never before had there been such a plague of locusts, nor will there ever be again.  They covered all the ground until it was black. They devoured all that was left after the hail—everything growing in the fields and the fruit on the trees. Nothing green remained on tree or plant in all the land of Egypt. (Exodus 10)

I don't even know if these bugs are Locusts.  Maybe a biologist out there can identify this green thing.    But whatever these palm-sized grasshopper look-a-likes are called they have infested our house and Kijabe in general.  OK is not quite a Biblical Plague, but these beady eyed green long-legged critters have found their way into our bathtub, bed, Mocha's doggie bowl, towels, the dental clinic, the back of our car, and on Meredith's baby doll (which she found very scary).

Name It Claim It?

Must a Christian have the “mission call” to become a missionary?  Is the mission call general and ubiquitous to Christians (the Great Commission) or specific (your tribe is the Hoaoranis in Ecuador)?  How do you decide on a sending agency(geography specific, denomination specific, ministry specific)?  How do you know if “the call” is really from God (It came in a clear voice) or perhaps I am feeling a well spring of emotions (I just finished a short term mission trip and can’t imagine being anywhere else but back in Africa)?   Can “the call” change over time or is it life long?  Should missionaries faithfully remain in one place or should a ministry have a beginning and end point at which time the missionary leaves?  How can we make short term missions more effective?   These are all good questions addressed in the recently published book “The Missionary Call”  by David Sills. 

    

I wanted to like this book.  And it seemed like I ought to like this book, but after I held more pages in my left hand than my right I don’t know if I liked this book at all.  I was too distracted by the language that I couldn’t remember whether the previous questions were answered or not?

This is a few sample texts that didn’t sit right.    

“The missionary call is about a burden to see hell-bound souls saved.”

“I bid you go and pull sinners out of the fire.”

“Develop a passion for reaching the lost heathens”

“50,000 pagans die everyday.”  (I’ve also seen blogs to this dramatic affect with a ticking clock count-up of those who have died just since I have been reading this blog. For the record the while I was on the blog the counter was already up to 179)  Is this suppose to instill some type of righteous frantic guilt?  

       

I’m really not post-modern or only about liberation/social gospel.  I think I fall in line with traditional protestant/evangelical thought (Bible is inspired Word of God, Jesus is both fully man and fully divine, Heaven and Hell are real).   But if this how evangelicals speak of those we are trying to serve?  Is this how we classify the sick, the broken, the poor?  Is my job description to “pull sinners out of a lake of fire?   If so I better start with myself.  I don’t think I am wrong but I don’t refer to my target culture as hell-bound, pagans, heathens, and sinners on their way to a “lake of fire.”  

On the other hand, I don’t want to diminish a real issue: What about those who have never heard?    What about the fate of the unevangelized.   Spiritual darkness and separation from God are real here in this world.    These two texts frame the fate of the unreached in my mind. 

God our Savior, who wants all men to be saved and to come to 

knowledge of the truth.  (I Timothy 2:3-4)

Salvation is found in no one else, for there is no other name under heaven given to men 

by which we must be saved. (Acts 4:12)

God wants all to be saved, but over 2 billion people in this world have never heard the Gospel message of Jesus Christ in a meaningful way.   I think many Christian struggles to reconcile God’s wide mercy, yet simultaneous specific plan for salvation.  And we keep struggling and grasping after texts like these. It’s a hard issue  

How you reconcile these New Testament texts becomes manifest in your view of missions.   Christians of all stripes have wrestled with the implications of the Great Commission in their own lives.  You might ask what does “taking the Gospel to all nations”  look like for me?  Some go. Some support financially. Some go on short term missions. Some tutor a child.  Some hand out gospel tracts.  Some build a home with Habitat for Humanity.   Some send. Some are dedicated Christian parents.   Some ignore.  Some make a great difference exactly where they are. Some are faithful deacons, greeters, elders and sunday school teachers in their church.   Some pray fervently. Some feed the poor at soup kitchens.  Some visit the sick and shut-ins.   Some lead churches to support missions.  Some don’t care.  Some are deeply burdened.

So this issue of those who have never heard is real (they need to hear the Good News), but we ought to be careful what language we use to define them.  The first step to define a group is to name it.     Are they undocumented workers  or illegal immigrants?  Is the movement the pro-choice or pro-abortion.  Are they pro-life or anti-reproductive choice?   Are they bicycle commuters or speed bumps?  And so it goes with each side seeking to win the argument by naming it in their favor.   

So how do we define “those who don’t know his name”?  Has it been tradition in the past to call them heathen, sinners, pagans, etc.   If we stick with that type of language we promote an us/them, in/out, we got the info you need/you don’t mindset.  Do we want to  keep that mindset when we are told to not cast the first stone, to take the plank out of our own eye, and to know that while WE were yet sinners, Christ died for US. I think we can find better language.

 In the end most language and metaphors (except for the Bible) fall short of his amazing love for us?  I remember seeing a diagram with cliff on the left and a cliff on the right separated by a deep chasm bridged by a cross dropped in the middle?   I remember hearing about a group of non swimmers in a lake needing a divine rescue floatation device?   God decided to whom and when would that floatation device be flung.  Then there is a middle school kid who deserved to fail with a 69 on his Algebra test..but the teacher rounds up to a passing grade to represent grace (a gift we don’t deserve)?  A death row prisoner gets a heart transplant and pardon from the President in the 11th hour (to describe atonement)?  I imagine a lot of these metaphors have really helped a lot of people.    

I like the different ways some Christian writers are painting God’s saving grace for us.

A Navy SEAL was performing a covert operation, freeing hostages from a building in some dark part of the world.  His friend’s team flew in by helicopter, made their way to the compound and stormed into the room where the hostages had been imprisoned for months.  The room  was filthy and dark.  The hostages were curled up in a corner, terrified.  When the SEALs entered the room, they heard the gasps of the hostages.  They called to the prisoners telling them they were Americans.  The SEALs asked the hostages to follow them, but the hostages wouldn’t. They sat there on the floor and hid their eyes in fear.  They were not of healthy mind and didn’t believe their rescuers were really Americans.  The SEAL’s stood there, not knowing what to do.  They couldn’t possibly carry everybody out.  One of the SEALs got an idea.  He put down his weapon, took off his helmet, and curled up tightly next to the other hostages, getting so close his body was touching some of theirs.  He softened the look on his face and put his arms around them.  He was trying to show them he was one of them.  None of the prison guards would have done this. He stayed there for a little while until some of the hostages started to look at him, finally meeting his eyes. The Navy SEAL whispered that they were Americans and were there to rescue them.   Will you follow us? he said.  The hostage stood to his feet...then another, until all of them were willing to go.  (Donald Miller-- Blue Like Jazz)

I like this story and how God came and asked us to follow Him.  But we were resistant and reluctant.  Then He came down beside us like no other belief system or Religion talks of.  

This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins. (1 John 4:10).

And He rescued us.  

We Acknowledge Our Mothers Today.

    Madelle Friess is mother of four children (two sons and two daughters) and I am her third born child(1976).  She is also grandmother to eight (five granddaughters and three grandsons), one grandchild born every calendar year since 2002.  

     Jan Cichowski is Sara's mom.  She is mother to four children (three daughters and one son) and Sara is her first born child(1978).  She has three grandchildren (2 granddaughters and 1 grandson).  

       Just on cue at church when they were beginning to ask all the mother's to stand and be acknowledged Sara was paged and called to the hospital.  I guess another mother was appreciating our mother as well on this special day. 

Happy Mother's day to all the mother's out there.  We love you.

53 patients

53-the number of patients brought into our casualty Thursday morning after a bus lost control while being passed by a car. It was standing room only and overall I was again impressed with the function of our triage under such enormous patient pressure. How many other ERs get 53 trauma patients in one hour? The commonality of such trauma here is underlined by the lack of mention these events receive in the news. 

Should Mission Hospitals Be Self-Sustainable?

Is it reasonable for Mission Hospitals to operate such that patient fees are sufficient to cover all of the outgoing expenses?  Or simply put, should mission hospital be able to financially stand on their own two feet without help from outside donations? 

Yes.  

Christian mission hospitals should and must stay afloat on their own via patient fees without depending upon outside donations.  This is the only hope these hospitals have to last and provide any type of long term medical and spiritual impact on the community they serve.  

First, it is quite reasonable to expect that missions hospitals can be self-sustainable because payroll is low compared to the West.  Even for skilled workers like nurses, chaplains, and scrub technicians salaries of 250 dollars per month are very competitive. 

Second, in some countries there is national health insurance.  In Kenya as long as a patient is signed up for NHIF which costs less than 4 dollars per month all of their inpatient care and surgeries are paid for.   The reimbursements to the hospital are substantial and can more than cover patient expenses.  

Third, missionary doctors (who are free work and collect no salary) can not be counted on for the long term.  This is not an insult against lack of commitment by the missionary community but the realities of Westerners living in the developing world.  So many situations can arise including political instability, personal sickness, child-raising issues, lack of fund-raising, or change of mission focus are just a few reasons that may cause a sudden exit of a missionary doctor or the whole medical missionary staff.  What happens and at what level can a mission hospital function if the missionaries leave?  Mission hospitals must find a way to continue operating even if the missionary community leaves.    

Forth, mission hospitals can not rely on donations of finances, medical instruments, and supplies to stay afloat.  Donations are erratic for many reasons.   Financial donations rise and fall with the wayward economy of the West.  Some equipment is excellent and useable.  Other instruments are too technical and fragile to last in a dusty, high-use developing world environment without medical tech support. Some donated instruments are just plain out of date or non-functional and put in the category we call, “Junk for Jesus.”  Some donated items never arrive or are costly to import due to customs and taxes. Mission hospitals must find affordable streams of medical supplies in-country or in nearby places like India.

Fifth, mission hospital medical care in the developing world is often higher standard, more compassionate, and more expedient than the government hospitals. Certain patients will seek out the Mzungu (white) doctor for his or her expertise.   Some of these patients are middle class, have white collar jobs, and are able to pay for “private attention.”  Mission hospitals have a unique opportunity to capitalize off these “private” patients and charge fees that can subsidize the care for those patients that do not have the ability to pay.  

No.  

It is not reasonable nor should it be expected that a mission hospital could possibly be sustainable on patient fees alone.  Christian Mission Hospitals need and should be propped up by donations and the care given by missionary doctors for many reasons.  

First, the average Children’s Hospital in the USA relies on foundations and or donations at a rate of 30% of their overall budget.  If we don’t expect a hospital in the West to stand alone, how can we possibly expect our counterpart here in Africa to make it without help from outside donations.  

Second, operating a medical missions hospital is expensive.  Much more so than discipleship, church planting, or building a seminary.  It doesn’t make medical missions right or wrong, or better or worse just expensive.  Operating rooms, medicine, staff available 24 hours per day it all makes this type of ministry expensive.  To expect the meager fees to cover the operating expenses for things like hysterectomies, long term in-patient tuberculosis treatment, or out-patient medicines is not realistic.

Third, making the mission to treat “the least of these” in a hospital setting is a terrible financial decision, but glorious spiritual decision.  Mission hospitals target (as they should) the poor, the homeless, the jobless, the orphans, the widows, the rural farmers, the rejected (HIV+) who often have no income and no where else to go.  Patient fees are intentionally kept low such that no one is turned away.  Outpatient fees are often less than one dollar. A dental extraction costs less than 3 dollars.  A surgical c-section and in-patient stay is less than 100 dollars.   Despite honest work to round up money from family and community, patients often leave the hospital without paying and collection is rarely pursued (as expected).   Fifty percent of all Kenyans live as subsistence farmers on less than one dollar per day.   Keeping fees low to treat the poor and staying out of the red are diametrically opposite goals.  Business goals collide with spiritual goals.  Economics mixes strangely with ministry.   Biblical mandates (caring for the poor) contact paying the bills.     

Fourth, a noble goal of mission hospitals in nationalization.  That is training the national staff (nurses, doctors, administrators, technicians) to take over key positions in the hospital thereby replacing the missionary staff.  This is already happening at Kijabe.  Many of the consultants doctors, all the nursing staff, the CEO, and all the residents are African. This is a good thing!  But, no one wants to talk about the nasty hidden cost of nationalization of a mission hospital.  Missionary doctors (who work for free) are replaced with national doctors (who must be paid a reasonable salary or see them leave).  As mission hospitals become more nationalized they may rely further on donations to keep from sinking financially. 

I guess yes & no is the answer to "should mission hospitals be self-sustainable."  Likely, the right answer lies somewhere in between.  

A Woman's worth

The University of Washington estimated there were 342,900 maternal deaths worldwide in 2008 and more than half of all maternal deaths were in only six countries in 2008 - India, Pakistan, Nigeria, Afghanistan, Ethiopia, and the Democratic Republic of the Congo. Our maternal mortality rate at Kijabe is lower than the national average, but in reality the data is scarce as most women still deliver at home with unskilled birth attendants. 

We see between 60-80 women in GYN clinic each week and one of the most common chief complaints is infertility. What is the best help I can provide knowing childbirth is relatively unsafe? Women are far more likely to die giving birth then from infertility. Yet, these women will also be abandoned. Azia serves as good example. Married at 16 by arrangement in Somalia, she did not produce a child, so her husband took another wife and then finally divorced her at age 28. Her family promptly repeated the genital mutilation and returned her for her brothers to care for. Today she came for help. She wanted to know if she could have a surgery that would help her fertility so that she would be eligible again for marriage. 

When she learned that I thought a myomectomy and tuboplasty would help her, she profusely kissed and hugged me. Her entire societal value depends on her ability to conceive. And when that is gone so is her hope and her future. It's not just that she wants to have a child, it's that she has to bear a child to have any value in society. 

Recession

A weekend break

We had a great weekend traveling to Nakuru to visit friends from college Travis and Lydia Klingforth who have been missionaries to the urban poor for the past 6 years.  Pictured is Lake Nakuru, known for its amazing flamingo covered shores.

The girls were excited to see pink birds as well as many baboons, monkeys, zebra, rhino, buffalo and enjoyed doing so from our car which barely made it around the lake because of all the rain.

As a break during the ride we stopped and fed ostriches. These have to be about the ugliest things created and I'm amazed people want them as pets. 
After feeding the birds we took a horse ride down to Lake Elementitia. Meredith decided that horses are a bit scary but okay when old and slow. Amelia just wants a horse and so we have to remind her, "You don't get everything you want in life," but at least the 30 minute ride we paid ten dollars for actually lasted 90 minutes! 

Creativity

Maybe in your career (stay at home parent, teacher, accountant, pastor, construction, engineer, business owner) like ours, you find your day not so much filled with what you were educated to do (teaching, preaching, designing, leading, operating) but more filled with problem solving. Sara and I have both had many days like that:

1) Your resident is not here today and has asked for an emergency day off to get her hair done for a wedding. Can you talk to her?
2) Your patient is here (5 year old) from Mombassa (6 hours away) for full mouth restorations and our portable compressor is down. Can you talk to their family and let them know we will have to reschedule?
3) Another high-school student wants to observe a delivery in maternity ward (the last one fainted) and they have no medical experience. Should we allow people to hospital gaze? Do we need a policy? But we don't want to discourage people?
4) Our new financial management software for dental is up and running? How does it work? Don't we need another computer? We are now going to be collecting our own fees? Can we get a safe? We need another receptionist don't we? Can we hire?
5) The nurse midwifes are not comfortable with breach deliveries and the use of vacuum and forceps. They are requesting (if not demanding) more and more c-sections. How do we change the practice philosophy and their attitudes to get our c-section rate down?
6) The staff is not coming to devotions in the morning. Do I make it mandatory? Do we eliminate devotions and just see patient from the get/go? Are the devotions I'm leading just not relevant, inspiring, or interesting to their live?
7) Our phones lines at our house have not worked for 5 days. I have called maintenance 8 times. Sara is on-call tonight and needs phone service....what else can I do?
8) The patient is demanding infertility treatment..but she is single, or perhaps HIV+. Can you explain the ethical issues to this patient from a Christian perspective,,,and they only speak Kikuyu. How do I talk to them?
9) The country of Kenya is out of IV ampicillan. What should we do?
10) They already orally intubated your dental patient before you could arrive in Theatre, but you need access to the full mouth and needed nasal intubation. What to do?

These are just a few examples of the problems we try to solve each day (many don't get solved). Some do by God's grace. Having the ability to communicate clearly, compassionately, and patiently cross-culturally becomes a paramount skill. The mechanics and science of medicine and dentistry at times seem easy compared to managing these type of problems.

I think we as a family need creative outlets. Maybe you find this as well. Doing something that does not present with a problem (how can I fix it), but presents with a blank template (I get to create). Maybe this is gardening (an empty flower-bed), fishing (tying a new fly), book club (sharing a new idea).



I think kids have a lesson for adults in creativity. How much of their time (pretending, playing house, coloring, gluing, acting, dancing) is spent on creative activities? Indeed if we are made in the image of God (He is a creator) being creative is an important part of who we are. It does not take much. Amelia, Meredith, and a few rocks become a sparkly dust factory.



Sara and I have both found blogging as an outlet for creativity. A blank post is soon filled with opinions, pictures, feelings, and stories. Some fabric, an idea, and a used sewing machine and Sara is quilting.