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.

Plates & Screws

We are very grateful for all the individuals and churches that support our work and ministry here in Kenya. We are also thankful for the many companies that have responded for requests for equipment, instruments, disposables, etc. One company in particular that has helped us out tremendously is Synthes (www.synthes.com). They develop, produce and market instruments, implants and biomaterials for the surgical fixation, correction and regeneration of the skeleton and its soft tissues. We use there products to fixate unfavorable jaw fractures. With help from Samaritan's Purse for logistics (Scott & Mary Elizabeth) Synthes (Paul Gordon) donated two complete fracture kits of 2.0 and 2.4 mm plates and screws. This company has no direct connection or financial gain in this donation, just the desire to help out in the developing world.



We thank Synthes for their donation; and I think this Kenyan patient thanks you even more.

Take Your Kids to Work Day.

I don't think take your kids to work day exists here in Kenya (work is often too far for the kids to walk), but we decided it was time to bring this tradition to our home. Plus our kids and their (Nancy & Sarah's) kids were all on holiday. After Matatu service was arranged Sarah and Nancy (our helpers) took their kids to work (our house)! It is interesting to me that they have house-helpers in their homes as well. Nancy has 3 daughters (Martha, Ana, & Joy). Sarah has a son (John) and dauther (faith).



John and Faith decided they wanted pepperoni pizza for lunch. It turns out they were not to keen on the mozarella cheese, but loved the pepperoni.



Meredith, Amelia, Ana, Joy, & Martha making necklaces with the always popular POP-beads.

4 Mandibular Anomalies

Indeed I see more different things in a month in Africa than perhaps a career as a GD back home. Take a look.



First Patient) 5 years previous 9 YOBM was in RTA. Experienced broken mandible at angle (L side) and was treated with ORIF. Never returned year later to have ORIF removed. Came to our clinic today (at age 14) complaining of... and with visible localized swelling in parasymphaseal (L side). Palpation is firm, no pain. Closer look on x-ray shows tooth # 20 failed to erupt caught at inferior border of mandible superimposed by ORIF.



Second Patient) 70 YOF. No Pain. Edentulous. Motor Vehicle accident 1 month previous.



The fracture (L side) is one month old. Malunion has occurred. No mobility of the mandibular fragments, swelling, or puss. Patient has surprisingly normal ROM.



Fracture and badly displaced segments. Patient declines surgery and wants new denture fabricated.



Third Patient) 63 YOBF 1 year after full mouth edentulation. Chronic intraoral draining fistula and necrotic mandible exposed on R side. All indications point to osteomyelitis of the mandible.



Fourth Patient) Determining if patient can touch his shoulders together (He can not). No sign of Bifid ribs or Basal Cell Nevus Syndrome. Notice very little extra-oral swelling.





Two years previous 17 and 32 were extracted and biopsy was taken. The biopsy was positive for Odontogenic Keratocyst (OKC). You can see how this cyst has extended from body of mandible up into ramus and well within coronoid and condyle. Little if any intra-oral swelling is seen.

Your Generosity Has Done This...Part IV

This is Sarah our house-helper and her two children John (6) and Faith (2). Sarah has worked hard for many years with various missionary families to become an outstanding cook. I'm not sure how we became fortunate to have her with our family 3 days per week. She cooks delicious pizza, chicken curry, enchiladas, and potato soup with a joyful spirit.

Around Christmas time we asked Sarah if there was anything that would help out her family that would be sustainable. She indicated that she had always wanted electricity for her house but it was always too expensive to have the electric wire run to the house, the meter installed, and the house wired. The total cost was about 28,00 KSH (400 USD). But the month to month cost of paying her electric bill she could manage as it would be offset by the Kerosene for her lamp that she would not have to buy.

Sarah made the written application. She hired an electrician to wire her house. Her application to Kenyan Power was accepted after a few months. Thanks to your generous donations into our project account Sarah was able to pay the fee to Kenyan Power for electricity! She now has working electricity in her house for the first time.

I asked Sarah what was her favorite thing about having electricity. She said, "you know now we can spend more time outside in the garden while it is light, but I can cook dinner for our family at 8:00 PM (normal dinner time in Kenya) and see what I am doing. And also Jonathan doesn't have to remain after school, because now he can do his homework at home in the evenings under our light."

Sara wrote the following thank-you note to you...

We are pleased for your support, thank God for electricity. Before I was using candles and kerosene, of which would give little light. But now no more darkness! We can easily prepare food and the kids can do studies without problems. Thanks for a helping hand. You are great and to be blessed.

Thanks from: Joseph, Sarah, John, & Faith

RTA (Road traffic accident)

This is the scene of our ER Friday morning. 20 injured people brought into Kijabe because a bus and lorry collided as the bus tried to overtake the lorry. I was called because 1 woman was pregnant. Malin was called because of the multiple jaw fractures. The pregnant woman also had an open book pelvic fracture-- and when I saw that on her x-ray rushed to get someone from Ortho help me sheet her pelvic. 8 people died at the scene. An 8 month old arrived having lost his mom at the accident. As awful as the scene was, it was amazing what our hospital could actually do and did. While we don't have emergency drills, we do have an emergency high casualty plan and for the most part it worked. People got their X-rays, C-spines cleared, IVs, and those who needed to be were intubated and taken immediately for surgery.

That being said, driving here will always be one of the most stressful things we do. I can't even describe the general chaos on the road, nor the recklessness people have when passing and let me just add they pass ALL the time. How we sincerely pray for God's protection as we travel!

Original Sin

"Mommy, I want to wear the dress Claire gave me,"
"No Meredith, your dress is fine. Do you want a snack before your nap?"
"Yes Mommy, can I have cereal?"
Bowl of cereal poured. Mommy goes upstairs to get something. Comes down to find Meredith, the table and floor, covered in cereal, and Meredith crying, "I need a new dress; this is wet."
"Meredith did you do this on purpose?"
"Yes Mommy, I sorry, but I need to wear Claire's dress," she says through the tears.

Well, now Claire's dress and cereal are not part of Meredith's life for 3 days.

The ministry of Presence

Grief comes to each of us at some time in our lives. There’s an inherent unfairness in grief... unfair in who and how it’s dispersed out. You can always find someone who’s circumstances trump your own: someone with more miscarriages, someone with more death in their family, someone who’s circumstances seem greater to bear, but that certainly doesn’t provide comfort and perhaps even brings guilt.

It’s hard to be present with someone grieving. Who really just wants to weep with someone? Isn’t easier to give advice about why this happened, quote Bible verses, offer spiritual idioms, try to provide a cheerful spin, or share personal experiences?

And yet the grieving need comfort and assurance. So how do I provide that as one grieving ministering to many others grieving? In Kate Brasestrup’s book “Here if you need me,” she writes about the ministry of presence. The ministry of “just showing-up.” While it sounds easy, I think for most of us it turns out to be a hard discipline. We read of Jesus doing this when he learns of the death of his friend, “Jesus wept.” We don’t read of Christ saying, “All things work together for the good of those who love Him" or “You’ll see him in heaven” or “I’ve arrived; don’t worry. ” And the miracle of the resurrection only comes after Christ presently ministered with tears to the family grieving. Being present, being willing to stay in the grief until it has passed is not wallowing, weak, or wasteful, it is healing.

What's next (Part II)?

Thankfully, we worship a God who cares about our future (good books often help). DeYoung in his book ‘Do Something’ tells us I know exactly what God’s will for your life is. And it is found in 1 Thessalonians 4:3.

“For this is the will of God, your sanctification.”

Bang! Taaa-daaaa! Cha-ching! There it is... in one sentence. God’s will for your/my life is to be sanctified (to live differently, set apart for Him.) A little bit of an underwhelming answer at first?

Let’s look a little deeper at what this means. I would like to share five concepts from this book about God's will that have been helpful.

1) Just talking about the “will of God” can be a confusing thing. Are we suppose to find the “will of God”? Shouldn’t we already be doing the “will of God” each day? Doesn’t everything happen according to “God’s will” anyway?

2) God’s will has two sides, plus one:
a) God’s ‘will of decree’ is the first side. This is what God has ordained. It will happen. It is fixed and can not be thwarted. (I am God and there is none like me, declaring the end from the beginning and from ancient times things not yet done, saying, ‘My counsel shall stand, and I will accomplish all my purpose. Is. 46:9-10)

b) God’s ‘will of desire’ is the other side. This is how things ought to be. It is obedience. It’s the way God commands us to live, yet it can (and is often) disregarded. (The desires of the flesh and the desires of the eyes and pride in possessions-is not from the Father but is from the world. And the world is passing away along with its desires, but whoever does the will of God abides forever. 1 John 2:16,17)

c) There is a third side..but it is ours, not God’s. It it the “will of direction.” It’s what we think of when we ask all those questions in the previous paragraph...God when, God who, God how many? The Bible clearly tells us God has a plan for our life, but special revelation is rare. God doesn’t always (and sometimes rarely) answers our questions that have to do with the ‘will of direction’.

3) We can be obsessed with finding God’s will to the point that we become paralyzed to make a decision. First, we have an abundance of choices majors, careers, churches, restaurants, hobbies, etc....much more so than a previous generations. Second, rather than “reveling in the freedom, we find it agonizing.” Third, any decision we make (picking a major, buying a house, joining a church) cuts off options D, E and F (the other major, condo, or church).

4) God’s will is not like a Bull’s eye where we stand at the range, draw our bow, and fire. Anything less than dead middle is out of the center of God’s will. This sets us up for a false mindset. If we strike the bull’s eye we are destined to be blessed and happy. If we miss we are destined for failure, guilt, and hopelessness. Every decision from your chosen major to if you should buy a boat is racked with fear.

5) God cares more about the how (moral decisions), rather than the where, when and who (non-moral decisions). We tend to care much more about the non-moral decisions (should I go for further education or start my own business) than the moral decisions (am I being a faithful member of my church). Although which town you choose to live is important to God, He care’s more about whether you are running hard after him in that town. Although God is concerned with your career choice, He is most pleased when you are glorifying him in what you do at work through your honesty, excellence, and fairness with others. God certainly cares about who you marry, but He cares most about if you honoring Him by the way you love your husband or wife.

Many of the concepts ring true to us (maybe you as well) when we are trying to figure out God’s will for 2011.

God’s will can be confusing. At this time we feel we are doing God’s will (by serving in Kenya) yet also searching for God’s will (what would you have us do next).

We believe God’s “will of decree” is already done and being accomplished simultaneously (His irresistable grace has freed us and God’s ultimate purposes will be accomplished).

God’s ‘will of desire’ we sense in an obedience to serve the under-served.

Right now there are an abundance of choices that can be challenging (so many sending agencies, where to serve, how to raise support, teaching hospitals, unreached areas, long-term, part-term, short-term, extending our term, volunteer-term, pursuing further medical education, collaborations with academic centers, or simply pausing for a moment) to navigate all the options.

Lastly, there is comfort knowing we proceed without fear that God’s will is not a bulls-eye that we may have struck or missed. He can work in our life in different places, times, situations, careers, and through different people as long as we are committed to living a life that is sanctified (different, set apart for Him).

What's next? (Part 1)

Put on your old college cap and go back to your senior year. Do you remember the question you were asked as graduation approached (whether it was dreaded or eagerly anticipated)....so what are you going to do next. As we advance into the latter third of our 2-year our post-residency program, understandably we get the same question....so Friess Family, what are you going to do next? Believe me I want to know the answer even more than the person asking.

It’s a serious question that deserves a prayerful, discerning response. I’ll tell you what the easy answer is...whatever God wills for us. Which is Christianese for, “we really don’t know right now, but whatever it is, it can’t be argued with because it comes from God.” But it begs perhaps the most popular and valuable question almost any person faith has ever asked; God what is your will for me?

God where should I go to college? God should I take the job that pays the most? God should I marry him? God should I move across the country for this opportunity? God should I be spending so much time in this hobby? God is this the right church for our family? God do I stick with it, or pack it up and find something new? God when do I start a family? God right now what is the best way to discipline my child? God am I right to hold my own or should I be apologizing? God is it the right time to get back into real estate or the stock market? God when do I retire and what do I do with my life?

Wouldn’t an all-knowing and all-loving God be 1) able to know what is the best path for your future and 2)and also want to tell you as His love requires that your best interests are close to His heart?

So how come almost any Christian at times in their life feels lost when it comes to knowing God’s will?

You Tube Video

Sara has put together some pictures and music of what is happening with our family in Kenya. With recently better internet service we have finally been able to link it to our blog in a functional form. I think you will enjoy it! The easiest way to view this 7 minute video is to double click on the video screen to the right (not the red play button) and you will automatically be linked to the you tube clip. Let us know if it works!

A new baby

I haven't posted any "baby" pictures for a while. But this baby deserves mentioning because he is the twin that survived severe pre-eclampsia, death of the other twin at 30 weeks, and born to a mom who had already delivered 3 still-births. He was born via C-section because of pre-term breech presentation and the first thing he did was scream.

What we are not.

There is perhaps nothing more frustrating than being portrayed as you are not. Tenwek (We Treat, Jesus Heals) and Kijabe (Health Care for God's Glory) are forthcoming in their Christian underpinnings. But I was shocked, angry, and saddened to find out what others assumed about how a Christian Mission hospital actually functions.

Let me share with you an excerpt from a book written by a volunteer NGO physician in Africa...

"When the work was done, many of them would smile, grab my arm, and say, "God bless you." People often asked if we are affiliated with any denomination. Our answer is, "No, we will work on you for free even in if you don't believe in Jesus." ....Our work does not trade (healthcare) for a commitment to attend revival indoctrination services. It is not necessarily to manipulate or reflect a dogma, but rather we demonstrate our love for human beings, by helping when needed. We do not pretend our culture is superior."

Please let me correct these misconceptions. And if you still have doubts you are welcome to visit.
1) We treat all patient regardless of race, religion, culture, citizenship, or ability to pay. We do not require a patient to have Christian name, carry a Bible, or claim membership to a Christian Church. In fact many of our patients do not believe in or have never heard of Jesus.
2) Our surgeries, medicine, and care comes with no strings attached. "Revival Indoctrination services" are not required. In fact I don't think I've ever seen a Tent Indoctrination service. We have a chaplaincy service that is available, not mandatory for any patient in need of prayer or counseling.
3) We do not manipulate or coerce our patients into death-bed confession. We do not withhold care or medicine until a decision or conversion occurs. On the contrary we seek to give them a high standard of compassionate healthcare such that patients get better.
4) We as a Christian Mission Hospital have set of beliefs that is anything but dogmatic. We have a sympathetic and humble attitude that you come broken, sick, hurting and in need of compassion, love, and healing.
5) We do not demand that our culture is superior. We respect our Maasai, Kikuyu, Kaligen, Kamba, Somali, Sudanese, Luo, Luya, Wahindi and all other other tribes and nations of patients. We do not try to make you into middle class Americans.

I hope these misconceptions about Christian Mission Hospitals are rare and quickly disappearing. And above all I pray these misconceptions are never true. Instead lets us be known as Christ has commanded us.

For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me. Then the righteous will answer him, 'Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?' The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me. (Matthew 25:34-40)

Composite Shades

Some of the Kenyan tribes have preserved their traditional dress, culture, and pastoralist lifestyle. They have remained with simple diets relying on staples of rice, potatoes, and milk. They have avoided and also have little taste for western foods like soda, cookies, crackers, and other sweets. I find from a dental perspective that these patients have aesthetic, naturally white smiles, with little decay or stain.

Back in the states home bleaching trays, in-office zoom whitening, and other products like Crest Whitening Strips are becoming very popular to establish a whiter smile. Our composite (tooth colored filling materials) typically come in shades A-D and 1-4. Maybe when you have been at the dentist you have heard the dentist and assistant going back and forth, "I think she's a B-2, no look at the cervical she is really a C-3." Aren't we kind to categorize you by the shade of your teeth? Anyway, because of the whitening products new shades of composites like extra-light, and extra-extra light have been developed to restore anterior whitened teeth to achieve an appropriate shade match.

In Kenya we often have the opposite problem. We simply need some darker composite shades. Say a Z-4, as you can see in the restoration to the right (different patient from the full face picture). Many patients are not to blame for their brown teeth (quite honestly some don't care. Of which I can understand as they have bigger fish to fry in their daily life like putting dinner on the table tonight) . The brown intrinsic staining and pitting of teeth is often due to dental fluorosis caused by excessive fluoride in the water here along the Great Rift Valley.

But if their is a company out their making some new composite shades for the developing world please send them our way

TCK (Part II)

In 1990 the census determined that the total number of Americans living abroad is estimated at 3 million. The book ‘Third Culture Kids’ takes a needed look at understanding who they are, determining their profile, and estimating the best ways they can maximize their life.

Let me share a few interesting sections of this book that ring true with my experience with Missionary Kids (and Third Culture Adults) in Kenya the past 18 months.

1) They experience high mobility. In the past two years we have lived in 2 different countries, 3 different locations, and 5 different homes/apartments. We have all seen good friends come and go, some to return again some we will not see again. It can make people flexible and quick to initiate friendship on the flip side overly-protected.

2) There is a Painful/Realistic view of life. Poverty, sickness, neediness is ever-present. We hope this instills compassion and identity that we are “One in the Body” and not prejudice, blame, or simply fatigue.

3) There is a sense of Restlessness. Where is home? It can lead to a feeling of physical rootlessness but at the same time preserve the notion that home is not a physical place but an emotional place where you are loved by family.

4)TCK’s often develop many friendships because so many people come and go, but it is simply hard to maintain them all.
Five levels of friendship are specified:
a) Superficial- Small talk. How are you? Where are you from? How is the weather?
b) Still Safe- Exchanging no Risk Facts. Where did you go on Vacation?
c) Judgmental Level- We being to risk a few questions sharing opinions on religion, politics, child-rearing. d) Emotional Level- Sharing how they feel about life. I’m happy, depressed, anxious, homesick, encouraged. e) Disclosure Level- Revealing private ideas and difficult failures. Involves and honesty and vulnerability that leads to intimacy.

Most only have a few if not just one person who fits in the 'Disclosure' level of friendship. Some have no-one like this in which to share. TCK’s and TCA’s move quickly through levels a and b to reach c. Why? It may be a sense of urgency due to high mobility of friendships. It also may be cultural. Europeans are quick to launch into talks of politics which may be divisive. Americans look for common ground in sports, TV, movies.

5) TCK’s are quite comfortable talking to adults because they spend a lot of time with them. They can seem overly-mature for their age.

6) There is frequently unresolved grief due to the stresses of normal life in a developing world (death, isolation, anxiety). In these situations comfort is often confused with encouragement. Comfort says I can’t change things. Comfort puts and arm around a shoulder and just says I’m sorry. Comfort validates grief. Comfort gives grief permission. It recognizes that this grief is normal, understood, and that the griever is not alone. Encouragement presumes this situation will turn around. Encouragement tends to bypass grief, often unintentionally delegitimizing the grieving process.

7) Both spouses must favor the move to a third culture for it to work.

8) Kids need to be feel that the work there parents are doing is important. First they just need to know what Mom and Dad are doing at the hospital. Second, they need to know that at this time God has called not just Mom and Dad but our whole family to serve in Kenya. If there is no sense of calling, need, or justification for being here for the children, they may feel they have been absconded to a foreign country with no real reason.

9) Establishing a physical home in your home country is recommended.

10) Build strong ties with relatives and friends.

Lastly, you may find a few graphs taken from the book interesting.



Safety of missionaries (thankfully) has vastly improved.



A tendency towards TCK's who are in boarding school towards higher frequency visits at home with parents.



The trend is tending away from early boarding school.

The authors in my opinion decidedly refrained from offering a tight summary or study of how TCK’s function as adults. Making an assertion would oversimplify the complexity of growing up as a TCK and its affect on the rest of their life. It seems that each TCK has a distinct experience and would speak for themselves regarding how growing up in a Third Culture has affected their development.

TCK (Part I)

I think parents occasionally pause to reflect about how the life they have chosen or feel called to live (working vs. stay-at-home, urban vs. rural, public school vs. private) is affecting their children. Coming this Fall Amelia will have spent nearly one-third of her life and Meredith over one-half of her life in Kenya. How is this affecting them? What are the benefits and challenges? How to they see their Passport Country and their Host Culture? How will they deal with past and upcoming transitions? How do they answer the seemingly simple question; Where are you from? (Northwest US, Akron, Kijabe, Tenwek?) Maybe I am way over-thinking how a couple years in Africa and possibly longer might affect my 6 and 3 year-old daughters. It was a due to a recommendation of a book by authors Pollock and Van Recken in which I found that Amelia and Meredith have a name; they are called Third Culture Kids (TCK).

Third Culture Kids are defined as, "a children who have spent a significant part (more than a few weeks) of their developing years (between ages 0-18) outside their parents' culture. TCK’s build relationships to all of the cultures, while not having full ownership in any (they can belong everywhere and nowhere at the same time)."

Maybe you are a TCK as well.

You may ask why it is referred to as a THIRD culture? Amelia and Meredith are growing up in Kenya. Isn't that just a second culture? Not exactly. America is their first culture. Kenya would be their second culture. The Kijabe Mission Compound including their school at RVA would be considered their “Third Culture.” Kijabe certainly isn’t America, but it’s not typical Kenya either. Like a child who grows up on a foreign military base, business enclave, or for Amelia and Meredith a missionary compound, each place has its own distinct style, vocabulary, and pattern of life that is different from their home or host culture.

Princess Band-aids

Meredith said she had two itches and was proud to show me her medical care.

On Call

Sara is on call this weekend until Monday morning. We as a family stay near the hospital and Sara carries her pager wherever she goes and sleeps much lighter. Call seems to be one of the most controversial (let's count the call schedule for the month including holidays), tiresome (I'll be working the next day too), and challenging (where is the needed surgical staff and residents at night) parts of being a physician.

I make jokes as a dentist that I take call 24/7 in case of an avulsed tooth, dislocated jaw, dental cellulitis. It can be demanding, but I bear this burden and they have yet to give me a pager at Kijabe....but I don't get as much as a smile from my physician colleagues.

Sara's call can vary from just a few phone calls regarding patient management that she can coordinate from home to being up all night in Theatre doing c-sections, treating patients with bleeding, shock, seizure, coding, etc.

One of Sara's least favorite parts of Call is the dark walk past the cemetery, around the open field of trees, around the pediatric tent, into the main gain with sleeping guards (knock, knock, to wake them up), through the noisy gale force winds of the Kijabe night to the Maternity Ward.

Sara's good friend brought back Mace. This is no ordinary Mace. It comes with 10% Pepper Spray (maximum strength) and Finger Grip Dispenser for maximum accuracy. We hope Sara never has to discharge her weapon, but beware this deterrent is Hot Pink!

Complicated pregnancies

I saw a patient who was now 28 weeks pregnant. What made this so significant is that she has lost 9 pregnancies between 10-20 weeks. About 4 months ago I put a cerclage (a stitch to keep the cervix closed) and started her on progesterone. There she was hoping for a good outcome this time, praying for a live baby to hold. Then I saw a woman 32 weeks pregnant with twins (one having died in utero at 28 weeks) who had previously had 3 stillbirths from hypertension. Her pressure was high today, so she's admitted, getting steroids for lung maturity and will likely be delivered this weekend when I'm on-call.

Sometimes the stories I hear I don't want to even believe because it seems so cruel the suffering these women have faced. Yet I know God is love and that God loves these women. And so, I cling to that.

10 things Amelia has learned while living in Kenya.

1) I can make glasses from leaves and lipstick from a spice.
2) I can read to chapter 4 in a Junie B. Jones book.
3) I can text message my Dad. (Yes, Amelia has her own phone..are we the only parents who track the whereabouts of their six year old with a cell phone?!)
4) I am learning to sew a quilt on the sewing machine.
5) I can count to 10 and play Simon says in Swahilli.
6) Pesto Pasta is my new favorite food.
7) Reading my Kid's Bible in church does make the sermon go by faster.
8) My 3 year old sister Meredith wakes up early and always talks a lot.
9) I sometimes get carsick here because the roads are so bumpy.
10) I didn't really want to go to school at first, but I never knew first grade could be this much fun.