Sunday, December 16, 2012

Healing and Violence

Wall hanging at Amani ya Juu - Nairobi, Kenya

Blessed are the peacemakers: for they shall be called the children of God.
Matthew 5:9 King James Version
And the peace of God, which passeth all understanding, shall keep your hearts and minds through Christ Jesus.  
Philippians 4:7 King James Version

We live in a violent world that is awaiting the Prince of Peace - Peace that comes from outside of our ideas, policies and medical care.  That is the good news of healing in a violent world!   

I once heard the definition of “hero” as that person who provides safe spaces.  He/she brings calm, perspective and action to the chaos that is a part of the violence that surrounds us.  We have seen that in tragedies and in places like Amani ya Juu.

There is another critical component of that Peace, Justice.   These two ideas, “Peace” and “Justice” are found in the Hebrew word “Shalom”.  The Prince of Peace is that wonderful gift, Shalom, to a world in chaos.

To build His Kingdom, we need to be those Jesus followers who build those safe  and just spaces.   We need to find and see again the healing found in the  “Shalom of this Season”.  


Marvin 

References
http://www.amaniafrica.org/
Post January 23, 2011, Peace from Above





Saturday, December 8, 2012

A Royal Birth


Tenwek Hospital, Kenya
And he sent them to preach the kingdom of God, and to heal the sick. 
Luke 9:2 King James Version

Once in royal Davids city,
Stood a lowly cattle shed,
Where a mother laid her Baby,
In a manger for His bed:
Mary was that mother mild,
Jesus Christ, her little Child.

“Once in Royal Davids City” - First verse, Christmas Carol
Lyrics C.F. Alexander  Music H.J. Gauntlett

There is nothing like a the excitement of a royal birth and how appropriate at this time of the year.   Let me share another recent great birth story.

It was the first part of this year(2012) while at Tenwek Hospital in Kenya that an abandoned term infant was brought to the nursery.   He was in a very tenuous state of health and named, Daniel, by the nurses who knew he would need to be strong to survive.  A few days later, it was discovered that he had been named Emmanuel by the police who had found him.   The resulting name was Emmanuel Daniel.  With a lot of love and care Emmanuel Daniel was nurtured back to health.   

This Christmas we celebrate the surprise and joy of a Royal Birth.  The surprise is that God appears to the poor disenfranchised world and provides a new definition of Royalty and Kingdom that is still in the making.  His Emmanuel’s birth is more like the reality of birth in the world in places like Kenya.   

May the blessings and surprise of this Royal Christmas birth be with you this year.

Marvin

References
Post December 12, 2011, Emmanuel
Post December 2, 2012, Awaiting “Good News”

Sunday, December 2, 2012

Awaiting "Good News"



God, my shepherd!
    I don’t need a thing.
You have bedded me down in lush meadows,
    you find me quiet pools to drink from.
True to your word,
    you let me catch my breath
    and send me in the right direction.


Even when the way goes through
    Death Valley,
I’m not afraid
    when you walk at my side.
Your trusty shepherd’s crook
    makes me feel secure.


You serve me a six-course dinner
    right in front of my enemies.
You revive my drooping head;
    my cup brims with blessing.


Your beauty and love chase after me
    every day of my life.
I’m back home in the house of God
    for the rest of my life.

Psalm 23 (The Message)


At this time of Advent in the church calendar, we are awaiting the “good news”.  It is what we all want to receive.  Sometimes in our lives, hearing “good news” seems more important particularly when our lives are challenged  by suffering and loss.   

Professionally, I have been interested in how physicians communicated “bad news”.  It is a common problem for physicians.   We have largely seen this communication problem from the perspective of the “giver” of the bad news.

We also have the opportunity to be a vehicles for the “good news”.   I have seen it in the concern and radical love of those who provide the care that is more than their technical skills.  We can be part of that unexpected intrusion in our lives by a God who has promised to be with us even when we together with our patients face “bad news”.  What we know is that when God intervenes in our lives it is always “good news”... like that first Christmas when God surprises us with new life.

Thanks be to God for the “good news” of this season when we celebrate God’s greatest “Good News”, Emmanuel.

Marvin

References:
Previous Blog Post, Emmanuel, 12/18/2011

Sunday, November 18, 2012

Healing Communities - "For the Greater Glory of God"


"Running Water" in Nicaragua from “Called to Life”

The poor in spirit see and are glad
Oh, you God-seekers, take heart!

For God listens to the poor,
He doesn’t walk out on the wretched.

You heavens, praise him; praise him, earth;
Also ocean and all things that swim in it.

Psalm 69: 32-34 The Message

"Community" usually has a small definition.  Our circle of church family, friends and relatives were defined by a 25 mile radius.  We got our news locally as well as our care.   We still see the value of small and close communities, but are now blessed with global relationships and connections.

Here are some recent observations about our expanded healing communities:
  1. The church and faith are global and the context of healing.
  2. Those who suffer bring a powerful voice of comfort and courage.
  3. Healing is learned best from those with longterm struggles.
  4. Their struggles are our struggles and our struggles are their struggles.
So the good news for our struggles in “developed” countries, is that our healing can come from places that we never expected.  Their faith is a testimony to our God who is bigger than our expectations or struggles!

Marvin

References
"For the Greater Glory of God" - "Ad maiorem Dei gloriam” - Motto at Georgetown University
Bono’s visit to Georgetown on 11/12/2012




Tuesday, November 6, 2012

HIPPA and Healing


"Mountain Home”  -  ETSU - October 21, 2012

Jesus said, “Go home to your own people. Tell them your story—what the Master did, how he had mercy on you.” The man went back and began to preach in the Ten Towns area about what Jesus had done for him. He was the talk of the town.  
Mark 5:18-20 The Message

We get some mixed messages when facing disease...”telling & sharing” or “privacy”.   In the United States, we have “legalized” our privacy...”HIPPA”.   In its simplest form, it is about the management of our health information.  The other reality is that our communities are keys to our healing and we can use computer communication to share information on sites like “CarePages”.   

Certainly, churches and church families regularly pray for and with patients who are part of their congregations.  I think we need to be clear about how our faith communities can be part of the healing response.  Susan Dunlap reveals the different styles and looks for the common themes.   Most important is God’s presence in the our lives.  Our faith stories are not just stories of our struggles, but testimonies of God’s healing.  These cyber-communities are our new reality of sharing and reporting God’s Grace!  

Marvin

References:
Rev. Will Willimon,  Jesus’ Health Care Plan


Susan J. Dunlap Caring Cultures: How Congregations Respond to the Sick

Ziebland S.  Wyke S. Health and illness in a connected world: how might sharing experiences on the internet affect people's health?. Milbank Quarterly.  90(2):219-49, 2012 Jun

Rev. John Hage, A Love That Won’t Let You GO, 10/28/2012

Tuesday, October 30, 2012

God's Grace



"Hey, I'm Dan and I hear you guys need a ride,"
Dan Todd, Coast Guard Rescue Swimmer

It is not easy to write about “God’s Grace” in the face of disasters and loss.  It is certainly not the words that I hear on the news reports covering Hurricane Sandy.

Despite that reality, I have seen God’s grace in the concerns expressed and organized by and in caring communities.  It happens by preparation, rescue and recovery.  Those realities also occur in our personal lives when we are threatened by “storms” that we name as diseases that profoundly change our ordered and ordinary lives.  

So here is how I would describe God’s grace.  It is that “extraordinary” reality that we see when God intervenes.  It is not about the disaster or disease, it is about the responses we see in the community of faith and those organizations that are the healing agents.  Help us to see the reality of God’s healing and blessings in our communities and our lives even during life’s storms.

Marvin

References

See message by Rev. Ernie Thompson, “Hardships and Blessings”, 10/28/2012 at First Presbyterian Church Wilmington, NC








Thursday, October 11, 2012

Thoughts



Si on soumet tout à la raison notre religion n'aura rien de mystérieux et de surnaturel. Si on choque les principes de la raison notre religion sera absurde et ridicule.” 

“If we submit everything to reason our religion will be left with nothing mysterious or supernatural. If we offend the principles of reason our religion will be absurd and ridiculous.” (Pensées #173-273)

Le cœur a ses raisons, que la raison ne connaît point.”

“The heart has its reasons, of which reason itself knows nothing.”
(Pensées #277)  Blaise Pascal(1623-1662)



Blaise Pascal, a French mathematician and philosopher, addresses the assumptions of both his worlds...worlds that seem to exclude each other!   That was a long time ago!  So how are we to address this tension in our world?  Where is the credible and grande “middle” space?  

It is said that French is the language of “Love” or maybe the secret is how it creates that space in our lives.  What is that space like?   What words or behavior convey that sentiment?  There is no question that it is a critical element in our lives.   

I have been the recipient of a “Love”.  It was and is a gift.  It was not words per se, but the lives that have been shared because of a faith.  It was and is a deep connectedness and commitment found in the hearts of others.   Mystery and reason live together in a space created by that “Love”.  There is no conflict, just gratitude!

So in our world of facts and evidence, let us continue to make room for mystery and reason in a space made in and by that “Love”!


Marvin

Sunday, September 23, 2012

Healing Words

Rosetta Stone

Reçois favorablement les paroles de ma bouche Et les sentiments de mon coeur, O Éternel, mon rocher et mon libérateur!  Psaumes 19:14 Louis Segond (LSG)

May these words of my mouth and this meditation of my heart be pleasing in your sight, LORD, my Rock and my Redeemer.  Psalm 19:14  NIV

I am in the midst of trying to relearn another language.  It is a challenge to find the right words!  More importantly, it has been an intense and difficult time in our global village of finding the right words!   “Words” seem to have a power that we have never seen.   The power seems to come in that we can share the words to a wider audience at speeds we have never experienced. 

In our Western culture, the “first test” applied to the exchanged words is the “truth” test and in healthcare, we have come to believe that our first obligation to patients is to tell the “truth”.   Another obligation is to use words that are “healing”.    This standard does not deny “truth”, but it means our words and our hearts have another purpose that we need to consider and get right.  

In a recent email from a dear friend, I got a clear report about his care in the face of metastatic cancer.  The facts were clear, but more important was how he was cared for by providers whose hearts were as important as the reported facts.  

In what ever language or culture, we need to find those healing words and hearts.  Healing words have and will connect us and they are “good news” to a suffering world.  

Marvin


References

Here is a current example of other healing conversations:



Thursday, August 23, 2012

"Burnout" and a "Path Report"




A recent publication(8/20/12) in the Archives of Internal Medicine published from the Mayo Clinic reports that up to 1/2 of all physicians surveyed have symptoms of burnout.  This looks like an increase as compared to earlier reports of 1/4 of physicians.   What is more alarming is the authors know of no specific effective recommendation.
“Unfortunately, little evidence exists about how to address this problem.”
I think there are answers that look at “well being”.  Here is the conclusion of a reflection by Dr. Sharon Dobie,
“Seasoned clinicians who still love their work know that there is a path. It is well worn, if quietly traveled, by those of us who know that relationships with patients do have mutuality. Our patients and we know that they add to our lives. We both know that we have grown in self-awareness, in part because of the lessons learned in relationships with our patients. We both know that our interactions go best for both of us when we are mindful, coming to an encounter fully present and attending to the dynamic process happening around the narrative presented by the patient. The path is there. It is time to show it to our students and to teach them how to walk it, instead of simply trusting that they will discover it after some frustrating years of fearing they are lost.”

“Equipping Healing Agents: Sustaining Vocation” is a “path report”  that should be available at Amazon in September, 2012.

Marvin

References

http://archinte.jamanetwork.com/article.aspx?articleid=1351351

Dobie S. Viewpoint: reflections on a well-traveled path: self-awareness, mindful practice, and relationship-centered care as foundations for medical education. [Review]  Academic Medicine.  82(4):422-7, 2007 Apr.

Monday, July 16, 2012

"Green" Healing Agents

 




The earth is the Lord’s, and everything in it,
    the world, and all who live in it;
 
Psalm 24:1 (NIV)

A modern social virtue has been identified in the “green” movement.  How do we act as good stewards of the resources entrusted to us?   There are a lot of answers that address those resources that are external to us; but what about us, what sustains us?  
Whether we are in ministry or medicine, our communities have invested a great deal in our training and support.  How do we most effectively, efficiently and sustainably care for this investment?  In reality, most of the effort has been in addressing the “unsustainable”.   What hasn’t been addressed is what is sustains us as healing agents.
In the soon to be published book, “Equipping Healing Agents: Sustaining Vocation” the gifts that we have received as a part of God’s creation are addressed.  It is not a self-help or book on professionalism.  It is about a wider view of what has been given to us as we follow our vocation and how those gifts sustain us.  
Marvin

Tuesday, July 3, 2012

Vocation & Retirement

“Remembering Forward”
“Who do we want to be?”
On Being with Krista Tippett
9/8/2011

“It's a poor sort of memory that only works backwards,' says the White Queen to Alice.” ― Lewis Carroll, Alice's Adventures in Wonderland & Through the Looking-Glass

 Brothers and sisters, each person, as responsible to God, should remain in the situation they were in when God called them.
1 Corinthians 7:24 New International Version (NIV)

“You are retired?” is the most common question when I meet colleagues that I haven’t seen recently.   It is a reasonable question since most of my medical school colleagues are retired.   The better question for me is what does vocation look like at the end of full-time practice?

There are a lot of books about retirement and even some studies regarding surgeons.   It seems to me that approaching the question from a vocational perspective is different than most of the books and the studies of physicians.  A report from physician Dr.  N. Thomas Connally gives us his personal and vocational account of retirement. (Select this report by clicking on it to see his video report.)

Vocational questions mandate looking back at the “direction of your life” and naming the “call”.  The good news is that “age” gives us the benefit of seeing our story and its themes.  Sometimes we find the answers and examples in other vocations.  The CD “Paul Simon Songwriter” is a wonderful summary of the vocation of Paul Simon.   We would not even think of asking the question, “When are you going to retire?”   He will always be “Paul Simon Songwriter”.

For me the question of retirement from being an actively practicing physician does not have vocational meaning.    The real question is not retirement but vocation.   What new aspects of my vocation do I need to address?   What are the missing pieces that have yet to be mastered?  I have come to believe that my “call” has not changed even if full time practice stops.  

Marvin


References



Luce EA. The ageing surgeon. [Review] Plastic & Reconstructive Surgery.  127(3):1376-83, 2011 Mar.

http://www.paulsimon.com/us/music/songwriter


Monday, June 18, 2012

Hope

“In a "medicalized" dying death is regarded as the great enemy to be defeated by the greater powers of science and medicine.”
Allen Verhey. The Christian Art of Dying: Learning from Jesus (Kindle Location 107). Kindle Edition. 

The recent book, The Cost of Hope,  Amanda Bennett chronicles the realities of end- of-life care in the United States.   It is a personal memoir of a fascinating, intelligent man written by a caring  and insightful wife.  Their story is not about lack of care but about the “medicalization” of death in our society.  It is an honest and powerful story even in her denial of what was obvious to others.   “Was I insane? Was I outrageous? Not at all, he answers. You were typical.”

Allen Verhey, writing from a perspective of a Christian bioethicist facing a lethal disease, describes the medicalization but also sees another dimension of dying.  He sees “Hope” not in the technology, although he is grateful for it, but in the community of faith and a belief in a larger Christian story.


So how are healing agents to behave in the the context of the medicalized culture?  What is key is our belief about hope and grace.   We must move to another facet of our faith as expressed in the arts.   A wonderful example is the music and images by Jonathan Elias  in the Prayer Cycle.   Here are two selections on “Hope” and “Grace


Marvin

Bennett, Amanda (2012-06-05). The Cost of Hope: A Memoir (p. 213). Random House, Inc.. Kindle Edition.



Tuesday, June 5, 2012

Healing Peace



Rejoice in the Lord always. I will say it again: Rejoice!  Let your gentleness be evident to all. The Lord is near.  Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.  And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.   Philippians 4:4-7 (NIV)

We are all confronted by questions that challenge who we are, what we have done and what we plan to do.  In the book, Not Sure, A Pastors Journey from Faith to Doubt, John Suk shares the struggles of his journey and vocation.   The stimulus for his deep distress are both the challenges of suffering and the failures of belief systems  that have not kept promises of progress.   His story is similar to Barbara Brown Taylors report, Leaving Church,  A Memoir of Faith.   Both are important voices of faith in a complicated world of change within and outside the church.
What resonates in my life is that despite our reflection and study, relief comes both in patience and actions...Patience in that quick answers are frequently incomplete and actions that build a new direction not a destination.   The “crisis of compassion” or “crises of faith” are examples of those difficult times that move us.  It is a common event of lives in transition.  It is a time of making peace with the realities.   
This healing peace does not leave us sitting!  Both authors end their books not with a spirit of loss, but with new directions.  These are lessons for all of us...a peace that transcends all understanding; a healing peace.
Thanks be to God for kept promises and moving us from thinking to action.
Shalom,
Marvin


Friday, May 25, 2012

"Everybody Dies"

                          Scene from the final episode of "House" - 5/21/2012


The ending of the story of Dr. House after 8 seasons of conflict tells what we all know about the statistics of medical care...”everybody dies”. * But is this all we can say? 

“Dr. House” ends with review and reflection as he addresses the meaning of death and ends with what looks like a “bucket list” of unfilled dreams.  He certainly makes the case that “life is hell” and that death looks better.  The ambiguous argument is portrayed in a pyrotechnic ending as only Dr. House could do!

In another look at life, Donald Miller in his book, A Million Miles in a Thousand Years: What I Learned while Editing my Life, sees life as a holy story.   Both narratives testify to pain and suffering, but there is a difference.  Donald Miller’s story also identifies suffering but ends with courage and hope that ultimately comes from his faith. 

“Do I still think there will be a day when all wrongs are made right, when our souls find the completion they are looking for? I do. But when all things are made right, it won’t be because of some preacher or snake-oil salesman or politician or writer making promises in his book. I think, instead, this will be done by Jesus. And it will be at a wedding. And there will be a feast.”

These “life stories” address “the meaning” of both life and death and I am thankful for both.  It has helped us all to see our own stories more clearly.   I love the clarity of the first question and answer in a 16th century statement that addresses the same difficult questions.


Heidelberg Catechism
Lord’s Day 1
Q & A 1
Q.
What is your only comfort
in life and in death?
A.
That I am not my own,
but belong—
body and soul,
in life and in death—
to my faithful Savior, Jesus Christ.

Marvin

References:


Miller, Donald (2009-08-26). A Million Miles in a Thousand Years: What I Learned While Editing My Life (p. 206). Thomas Nelson. Kindle Edition. 






Monday, April 23, 2012

Rx Ubuntu



“So I figured, if the entire world was one big machine, I couldn't be an extra part. I had to be here for some reason...”  Movie quote by Hugo Cabret in the 2011 movie Hugo directed by Martin Scorsese
For by the grace given me I say to every one of you: Do not think of yourself more highly than you ought, but rather think of yourself with sober judgment, in accordance with the faith God has distributed to each of you. For just as each of us has one body with many members, and these members do not all have the same function, so in Christ we, though many, form one body, and each member belongs to all the others.  
Romans 12: 3-5 (NIV)

There are ideas that you learn about and ones that you experience.  If experience is first, we then try and attach a word or concept to that experience.  Looking back at our experiences in Kenya, we felt a deep connectedness to the Tenwek community that is hard to name.   When in South Africa visiting the townships, we were introduced to the African concept of “Ubuntu” that has deep roots in that culture.   
Shortly after returning, I read the Diana Butler Bass book, Religion after Christianity and again there it was, “Ubuntu” as articulated by Archbishop Desmond Tutu.  Could I put our recent experiences into this big idea of “Ubuntu”?  I needed a new voice, a cross-cultural voice, one that knew and lived in both cultures.   Enter Rev. Dr. Michael Battle!     
What I learned is that “Ubuntu”  is an important Christian idea that generally has been missed in our Western culture and Christian theology.   How did we miss it?   Even when apartheid was being removed by the church that supported it,  what did we understand was the theology to replace it?   I missed it!   Well, probably what really happened is that even though I heard the concepts in the message of Desmond Tutu on January 19, 1986 in Duke Chapel, I had not experienced and named it!
So for slow learners, we need new examples.  What maybe is happening is that we are now understanding the concept in other ways... in movies like Hugo, with its message of interdependency and the critical importance of purpose (telos) in our lives.  Now, I hear the message of “Ubuntu” in the wonderful songs and rhythms of Ladysmith Black Mambazo and the ballads of Paul Simon.  Now we have a name for these experiences!   Thanks be to God as he continues to work in our hearts and minds.   
N’Kosi Sikelel’ lafrica (God Bless Africa),
Marvin
References:
Bass, Diana Butler   Christianity after Religion:  The End of Church and the Birth of a New Spiritual Awakening, HarperOne, 2012
Battle, Michael Ubuntu: I in You and You in Me Seabury Books, New York, 2009

Saturday, April 14, 2012

God, Trials and Fears


Conquering Fear on Table Mountain - Capetown, SA

But Daniel appealed to a steward who had been assigned by the head of the palace staff to be in charge of Daniel, Hananiah, Mishael, and Azariah: "Try us out for ten days on a simple diet of vegetables and water. Then compare us with the young men who eat from the royal menu. Make your decision on the basis of what you see." 
Daniel 1:11-13 (The Message)
Certainly people have been putting God on trial for a long time and Daniel’s account is one of my favorites partially because it is also the first reported clinical trial.   What seems critical to me is that it wasn’t just a clinical trial, it was a clinical trial that pointed not just to the results but pointed to God and Daniel’s faith.
 The “us” in the Daniel story are two social economic classes.   Will the “rich” win or are there other dimensions that are more important?   In a technical and complicated world our trials point more to confusion and chaos rather than the God of life that sustains us.
A contemporary version of the Daniel story is the relevance of the church and reality of 
faith in our lives...what we believe, how we behave and where we belong?*   The problem with the question is that it is more about “we” than about God.   The better questions are “What is God calling us to do as individuals and his Church?”.  What is grieving God that needs to be healed? 
For me, it is our deep-seated “fears” that somehow have escaped the faith that we have professed.   It has been “anesthetized” by our drugs  and diverted with a futile faith in technology, but it remains!   We are healed of these “fears” when we tell our faith stories and hear/learn from the ancient stories.   The good news is the church is still the location where we hear and tell God stories.**  These are stories of God’s healing work in the world.  This is the prescription for our “fears” and manna for our lives.
Marvin
Some recent references:
*Diana Butler Bass - 
Huffington Post - 4/8/12  - A Resurrected Christianity?
                     Book:  Christianity after Religion:  The End of Church and the Birth of a New Spiritual Awakening(2012)
**See Fuller Seminary Service with Father Greg Boyle, S.J. -
See Post: February 1, 2012 - Techniques and Transformation

Wednesday, April 4, 2012

Recognizing Healing

Surgical Procedure Board - Tenwek, Kenya

It was a day like many others at Tenwek Hospital(2/2012) when during rounds it was announced that two term pregnant patients arrived with seizures.  Both patients were diagnosed with eclampsia, both delivered.  The first patient’s baby was an early neonatal death, the other patient’s (JR) baby was small but survived.   The first mother improved quickly, but JR had evidence of renal failure, liver changes and the most obvious was her altered level of consciousness and subsequent hallucinations.   These symptoms required treatment with anti-psychotic medication.   Two weeks after presentation, JR suddenly became engaged with her baby, smiled and interacted appropriately with her family and providers.  Her renal failure and liver failure resolved. She remained in the hospital to continue to care for her baby.  


The reasons for resolution of this life threatening complication of pregnancy are only partially explained by her care.  What is most amazing is the long list of possible etiologies and mechanisms of injuries.  The patient and her family believe that she was healed.   Physicians and nurses use longer explanations about mechanisms and the sources of the dramatic change.   


These cases are a source of encouragement for those who work in very difficult settings with limited resources.   I believe that this case is a wonderful lesson in ”Let the living, teach the living” and another example of the “mystery of healing”!
Marvin
See previous blogs:
The Awe of Healing - January 15, 2012 
A Right Mind - September 5, 2011
The Mystery of Healing - April 17, 2011
Thackeray EM.  Tielborg MC. Posterior reversible encephalopathy syndrome in a patient with severe preeclampsia. Anesthesia & Analgesia.  105(1):184-6, 2007 Jul.
Belogolovkin V.  Levine SR.  Fields MC.  Stone JL. Postpartum eclampsia complicated by reversible cerebral herniation. Obstetrics & Gynecology.  107(2 Pt 2):442-5, 2006 Feb.

Monday, March 19, 2012

Fear, Freedom and Reconciliation




God has given us the task of telling everyone what he is doing. We're Christ's representatives. God uses us to persuade men and women to drop their differences and enter into God's work of making things right between them. We're speaking for Christ himself now: Become friends with God; he's already a friend with you.  
2 Corinthians 5:18-20 (The Message)
Visiting Robben Island is not just a lesson in history but a reflection of who we are!  There were three categories of prisoners; criminals, lepers and political prisoners.   The common element shared by all categories is fear.   The lesson we learned was the struggle for freedom from a former prisoner.   He was age 20 when he was imprisoned for being a member of the ANC.   He is now 49!   His work is telling the story of Robben Island as part of the larger story of reconciliation.  
That same day we attended a outdoor concert.  The group “Freshlyground” appeals to all ages looking not to the past, but to the future.   It is not unlike what we have seen in other parts of Africa and in the U.S.   What or who will continue the “healing”?   Will it be within and through the arts, economic policies, altruism or some religious response?   
For me, the answer is found in the reconciliation model that we see in the life and ministry of Christ.  It may find expression in the hopes and dreams of the youth, in the words of the music or art, but it’s Source is what gives me Hope!
Marvin
in Capetown, SA
Reference: The End of Words: The Language of Reconciliation in a Culture of Violence by Richard Lischer is a wonderful statement of the message of reconciliation.


Monday, March 12, 2012

Local Knowledge


"Africa to Anchorage"

Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be stilled; where there is knowledge, it will pass away.  
1 Corinthians 13:8( NIV)

This last three and a half years have taught me the essential nature of local knowledge in providing health care.   This is not a rejection of evidenced based medicine or new scientific discoveries.   The reality is that as clinicians we have the task of translation of evidence and new knowledge in response to changing demands.  Underneath that reality is a passion to make a difference!
When asked “Are you retired?” I respond that “I still practice part time anywhere between Africa and Anchorage.”   This changes the conversation from my age to “Wow, that must be interesting!”.  Well it is “interesting” but more importantly, I have come to appreciate the local realities of the delivery of care.
What I have seen are very dedicated healing agents who are willing to share their knowledge and responses to challenges.   I see people looking for more efficient and safe transport of patients.   I see nurses and physicians separated from family and their homes working diligently to learn and improve care.  I see frustrations with systems of care that interfere with the care they want to provide.  
What has also been wonderful for me is the great diversity of the patients and having a chance to sometimes, if only briefly, to be invited into their lives with its celebrations and losses.  In addition, I have been able to see education at its most basic as well as it’s most advanced.  But what excites me most is the passion and dedication at the bedside.  It is true that there is “burnout” and “frustration”, but there is another reality of local strengths and knowledge making a positive difference in the care of patients in many global locations!
Marvin
in Kenya
p.s.  Here are some references that you may find interesting.
Henry SG.  A piece of my mind. The tyranny of reality. JAMA.  305(4):338-9, 2011 Jan 26.
Smith DG. Viewpoint: envisioning the successful integration of EBM and humanism in the clinical encounter: fantasy or fallacy?.  Academic Medicine.  83(3):268-73, 2008 Mar.
Shaughnessy AF.  Slawson DC.  Becker L. Clinical jazz: harmonizing clinical experience and evidence-based medicine. [Review] [16 refs]  Journal of Family Practice.  47(6):425-8, 1998 Dec.

Saturday, March 3, 2012

“Standing Firm” and Pilgrimages

World Medical Mission "Chariot"

"It is always instructive to observe the life cycle of the First World aid worker.  A wary enthusiasm blooms into an almost messianic sense of what might be possible.  Then, as they bump up against the local cultural limits of acceptable change, comes the inevitable disappointment which can harden into cynicism and even racism...”  from When a Crocodile Eats the Sun by Peter Godwin. 2006 Little, Brown and Co. Publishers
“Therefore, my dear brothers and sisters, stand firm. Let nothing move you. Always give yourselves fully to the work of the Lord, because you know that your labor in the Lord is not in vain.”   1 Corinthians 15:58 (NIV)
Later God's angel spoke to Philip: "At noon today I want you to walk over to that desolate road that goes from Jerusalem down to Gaza." He got up and went. He met an Ethiopian eunuch coming down the road. The eunuch had been on a pilgrimage to Jerusalem and was returning to Ethiopia, where he was minister in charge of all the finances of Candace, queen of the Ethiopians. He was riding in a chariot and reading the prophet Isaiah.  Acts:8:26-28 (The Message).

One of the benefits of “getting away” is the reassessment of the direction and purposes of your life.  Being in Africa is a long distance from many of the assumptions that we hold about who we are and what we are doing in the world.   The dislocation takes time as you are confronted with people, places and beliefs that you may or may not share.
Pilgrimages and Lent share the common goal of reflection that prepare us for rededication and resurrection.   The tension is how we “stand firm” and yet “move”.   Will we see new opportunities, have new courage or just keep doing the same thing?  There is also the reality described by Peter Godwin that we could become cynical and discouraged.   
It seems to me that during these “trips” both are happening.  The foundation is rediscovered as well as new opportunities.  Not just doing the same thing, but finding those new people and truths that give us direction for the rest of the pilgrimage.  The larger context is we see the Isaiah story of faith that gives us courage and sends us on our way!
Marvin 
Tenwek in Kenya, Aftrica
See Posts:  Oct 31, 2010 - An International Healing Parable
                    Feb 27, 2011 - Pilgrimage and Healing