Tuesday, October 3, 2017

Helpless But Hopeful


The clinic day was drawing to a close, as our OB/Gyn was finishing up his last few patients.  Two nurses were still hanging around, talking and laughing with a few of our check-in staff.  The generator had been turned off and locked up until the next day.  The common sound of a motorcycle grew louder as the driver and his passenger stopped in front of the hospital. 

A 20-something young man, who looked pretty “street tough” quickly got off of the motorcycle and approached me.  “My child took a whole bunch of his mom’s pills and won’t stop crying!!”  he quickly and breathlessly shared.  “Where is the child?” I asked.  “Can you bring the child here? And any information about what medicine he took?” I asked as he turned toward the awaiting motorcycle, got on and said “I will be right back!”  I started looking at our inventory of what we had for such an event and realized we were dreadfully unprepared, but nonetheless, we were the only facility near to where the child lived.

After several minutes, the young man, the child and the child’s mother returned on the same motorcycle. The sound of the child’s moaning and wailing echoed throughout the hospital.  I carried the child into the hospital, and placed him into the arms of one of our nurses and asked her to take vitals and monitor him.  I then started quizzing the parents: 
·      “When did he take the pills?”:  About 10:00-10:30 (4-5 hours prior)
·      “What kind of pills?:  We think they are called  <a brand name I did not know>
·      “How many did he take?”:  We think he took 10
·      “What are his symptoms up to this point?”:  Crying without stopping, writhing, not able to focus

…and the questions continued, vomiting?  Diarrhea?  Fever? Etc etc.

So as I recalled back to my days in the ER in the US, what would we do?  Among other things we would contact the Poison Control Center and get their advice.  I was afraid to induce vomiting because of the time since the ingestion and the risk of aspiration.  Maybe the Poison Control Center would know.   So off I went to find the number.  I grabbed my phone, and, the internet was not working.  I kept trying but to no avail.  I finally found the number on a drug pamphlet in the pharmacy and dialed the number. 

“Poison Control Center.  You realize you are calling New York?”   “Yes, Ma’am, I really don’t care where you are if you could give me some advice.” 
By this time, I had contacted a Haitian pharmacist friend who had given me the generic for the med, and wished me good luck.

“Sir, what is your situation?”  With as much brevity as I could muster, I explained the situation medically.  “According to our toxicologist, here is what we suggest.”  She began with a list of things for us to do, and to most things she suggested, I responded with, “we can’t do that here.”  “Oh!  Well let me have you talk to someone else.”

After another conversation the second MD finally said, “well, what do you have there?”  I gave him the short list, he muttered some expletive and said,  “Well, what you have done and not done so far is good.  At this point, I would monitor and if things get worse, then move onto more aggressive emergency measures.  Good luck!”  That was the second “good luck” I had received.  I think they are like strikes:  3 and you’re out!

So, we waited.  Time crept slowly as the child screamed.  We continued monitoring, and watching,…… and waiting.  Finally, the wailing subsided.  The writhing slowed, and monitored sleep crept over him.  I put my arm around his father, who had been sobbing, and he slowly smiled, as if hope had once again found him.

We waited some more and  the little one asked for a drink of water.  Some sips were given and we watched some more.  Eventually, we had just a sleepy, normal 3-year-old with us, and mom and dad asked if they could return home.  After a little longer, we dismissed them, adding that they should bring him back immediately if anything changed. I am not sure what we would have done, but at least we had a few options.  Dad asked our security guard at the hospital to call a motorcycle to pick them up.  As they left the building, the dad gave me a hug and said two things in broken English:  “thank you!” and “God bless you!”

I am still not sure what I had done.  I really offered no real solution.  I had only made several calls and confirmed that we were doing the right things and not the wrong things.  Our staff and I had done our best with what we had but still felt woefully inadequate.  This had a happy ending but, what about the next child?  The next patient? We knew we had some work to do so we could be prepared for whatever came the next time.

The Poison control center was wonderful!  Not only were they attentive and offered help when I called, but they called again a couple of hours after the initial call and then again the next day.  They, like me, felt helpless, but wanted to offer me some hope and encouragement.

It is in situations like this that all of the medical training in the world can’t help, especially if all of the resources are not at your disposal.   It is especially frustrating because you know what to do, you are advised what to do, but you don’t have what you need to accomplish it. 

Photo Credit: maternalmedia.com 
Hope.  It is so important!   Sometimes even if we don’t know what to do, or what to say, just caring and being there can offer that modicum of hope. 
We as Christians are lucky!  We realize that so often we don’t know what to do or what to say, the feeling that we don’t have what we need to fix the problem.  If we simply ask, there is someone always around to buoy us and give us hope.  May we never forget that hope can be found if we just look for it.  Jesus guaranteed it!

“….for I am with you always…..”

Tuesday, August 29, 2017

Taking a Back Seat


It was a hot, busy Monday afternoon at Hôpital L’Eglise de Dieu Réformé in Saint Ard. Over 100 patients and their families were waiting and receiving care in the main area of the hospital as the all-indigenous staff directed, managed, and guided the needed treatments. The noise and activity flooded us with the awareness of the needs of the people around us.  

We soon buried ourselves in a quieter small office on the second floor of the facility, as the leadership team of the hospital began a necessary planning meeting. The discussion was focused on two main items: defining and funding the payroll taxes as described by the Haitian government, and defining the funding needed to move the hospital from a Monday to Friday urgent care center to a 24/7 hospital with inpatient services. The discussions began and the 30-minute meeting spread into an hour and then continued on.  

If someone during my career life in the US had asked me to attend a leadership meeting like this while there was patient care going on around me, I would have said “No, thank you! I am really too busy!” or “What are you, nuts?” But this time, it was different. This time as Kathy and I sat behind the other members of the leadership team, who are all Haitians, we listened. We provided less than 10% of the conversation but still found the all-in-Kreyòl meeting to be maybe not exciting, but definitely rewarding. This time, the staff was taking the leadership role. The staff was directing the conversation. The staff was getting excited about the possibilities. The staff was taking ownership. It seemed that a corner had been turned!  Kathy and I were taking a “back seat” in the project. Taking a back seat doesn’t come naturally to me (or many US folks) but has always been and continues to be a goal as we work toward indigenous sustainability here in Haiti.

As the meeting went on, the funds needed to sustain and grow the hospital were determined as closely as humanly possible. The reality of the financial magnitude of the project placed a small damper on the enthusiasm of the group but not to the point of making them overwhelmed. At one point, it was stated that, “We <Haitians> cannot always be dependent on Mission Haiti Medical <outside influences> but need to be as independent as possible.” If I could dance, I would have danced! Some additional expenses were fleshed out and the goals were determined. The meeting was adjourned.

The reality of the outcome of the meeting is that neither the Haitian staff nor Kathy and I knew exactly how we would meet the entirety of this new financial goal. No one had voiced that it seemed beyond our current scope but sensing that obstacle, and without saying a word, one of our good friends on the leadership team stayed behind, grabbed my hand and Kathy’s hand, making a circle of the three of us, and began to pray. He prayed that, if it is God’s will, that the hospital have what it needs to open 24/7 soon. He prayed that while some things seem impossible, with God all things are possible. He articulated the difference that a hospital in the area could save the lives of so many but still, God, we bow to you and your control. 

When the “Amen” was said, we embraced and parted ways. As we opened the door, the din of the hospital patients below the office re-entered our lives. The physical needs of the patients were once again brought to the fore as those with different medical crises were seen awaiting care. As we saw the needs spread before us, we again realized that the ability to care for all of them was far beyond the long-term scope of a couple of US missionaries. The ability for the indigenous Haitian staff to shoulder the whole responsibility of healthcare, at least in the current financial state of the area, is a ridiculous request. The amount of money needed to quickly improve the facility is just an outlandish thought. BUT regardless of the outcome, our job is to join hands, pray, believe, and follow the one who can make it all happen.

We continued to watch as the patients in front of us, one at a time, were cared for. The busyness and noise subsided. The line had finally disappeared and, at this moment, all there had been helped. One day at a time. One patient at a time. One prayer at a time. So until the next step, we work, often impatiently, to turn all of the projects over to God, the original “indigenous personnel”, who was, and is, and is to come.

Jesus looked at them and said,With man this is impossible, but with God all things are possible.”
Mt 19:26 (NIV)

Thursday, August 10, 2017

4 Questions to Ask When Choosing How and to Whom to Give


I recently had a family member ask my advice about how to choose an international organization that has children feeding programs. She felt convicted to set up regular giving, but didn’t know how to go about determining which organization was effective. She located one that provided rice to school children in a developing country. One thing I suggested to her is to ask the organization where they purchase the rice. The country where the school children live is a rice-producing country; if the rice is purchased and packaged in the US (possibly first grown in another country before being shipped for distribution to the US), then shipped for distribution to the children in the developing country, that may alleviate the child’s hunger, but what about the rice farmers in that child’s community? Is it wise to give away free rice in a country where families depend upon growing and selling it to feed their own families? In the long run, will that create more hungry children? Former President Bill Clinton learned this lesson, and in 2010, he made a public apology to Haitians for his trade policy of 1995 with Haiti. In an effort to help feed hungry people, he forced Haiti to drop tariffs on subsidized US rice, which ultimately put countless Haitian rice farmers out of business.  In his own words, "It may have been good for some of my farmers in Arkansas, but it has not worked. It was a mistake." 

This is just one example of the ways well-intentioned giving can go wrong, but just how does a compassionate person know which international organization to give their hard-earned donations?  Here are 4 questions to ask before partnering with an international aid organization:

1. Does the organization have an ongoing relationship with those “in the trenches”?  (And are the people in the trenches continuing to ask themselves the hard questions?) If significant funds are provided from the US, a high degree of accountability needs to be present. Is there frequent face-to-face contact between those representing the aid organization and those working on the project internationally? 

Example: Actually, this example has occurred in various forms more than once–the following is a hybrid of several conversations I have had. A US friend or acquaintance comes to me and says they have met a Haitian while visiting Haiti, and they have communicated since via phone (or Facebook, or email). The Haitian has a [fill in the blank: children’s home, medical clinic, school] that needs funding. “I feel like I should help them.  Should I send them money?“ they ask me.

There are opportunists and “ne’er-do-wells” all over the world, and Haiti is no exception. I would ask: have you seen the project? How much time have you spent there? Years? Weeks? Days? Hours?  How well do you know the individual in charge? What does the community around this person think of him/her? What is this person’s plan for long-term sustainability of the project? What are this person’s qualifications to run a project like this? If you can’t answer questions like these, it would be better to invest in a ministry run by someone else you know who can vouch for the project with answers to those questions.

2. Has the organization done its homework with the locals?  Before beginning a project, there is significant research to be done in the country to be served.

Example: Someone wants to build a medical clinic in Haiti. Sounds good, right? Have they asked the community if this is something they want? That is a good beginning, for sure. But many organizations stop there. If someone in my US neighborhood asked me if I would like an ice cream shop down the road, would I say yes? I do like ice cream! But what about the city planners? What about other ice cream stores in the area–would this put them out of business? In the medical clinic example, has the organization asked the local leaders? What about the governmental department dedicated to health issues (in Haiti, called MSPP)? Has the organization surveyed the area to determine what other medical services are provided nearby, so as not to duplicate? Are there indigenously-run clinics nearby that could use strengthening, rather than building a new one? We recently had another US organization visit our facility. They had funding and were on the verge of building a brand-new clinic, about 100 yards from ours! Unaware we existed, they began asking locals about nearby facilities. Once they visited ours, they decided to use those funds in another way, that building their clinic would be an unnecessary duplication of services. They did their due diligence.

3. Are the key players in the organization qualified for the project?  Effective international organizations understand that they need to partner with locals, because the underlying culture and specific challenges unique to that country are not readily understood by foreigners, even those foreigners living in that country for years on end. Add to that a foreign aid worker working outside of their scope? A recipe for disaster, for sure.  

Example:  Someone visits Haiti and falls in love with the country and loves the children. After several short-term visits, he/she decides to move to Haiti and open an orphanage, because they love children and want to help Haiti. My questions:  does this person have experience/education in the field of child development? Do they have experience with the business end of running an organization? Has this person become educated on best practices of orphan care? Gone to conferences, read books, met with experts? Have they had discussions with the child welfare department of the country’s government (in Haiti, called IBESR)? Have they asked the child welfare department in that country what their future goals are for orphan care? What uniquely qualifies this person to carry out this ministry appropriately?

Some might feel that questions like these take the “faith” part out of the equation. Having lived in Haiti for almost three years now, and working from afar for the 22 years prior, I can tell you that there is plenty more you will encounter living in a developing country that will test your faith! But developing sub-standards programs because you have not adequately prepared yourself is a disservice to those you intended to serve.

4. Is the organization investing in indigenous people and developing a long-term, sustainable plan?  Does the ministry provide training as needed, and have a plan over time to turn more and more over to locals? Does the mission continue in the absence of US players on the ground, or are the doors open only when there are foreigners present? Is the organization focused on empowerment or dependence? If the foreign aid workers could never return to that country, would the ministry continue or close its doors? 

These four questions are merely a starting point; different areas of ministry have their unique nuances, and answers to the questions above must be combined with knowledge of the particulars for that situation. And for sure, with God, all things are possible! Sometimes God calls us to do things that defy logic because He is in charge, and He knows way beyond what our minds can even comprehend. With each of these questions, as a Christian, we must bathe it all in prayer and look to our Maker for guidance!

Every day that we live in Haiti we learn new things. Every day. Many of the new things are culturally related; we could live the rest of our lives here and still learn new things about the culture each day. But we also learn new and better ways to appropriately and effectively serve God and the people of Haiti. If I had written this blog post 2 years ago, it would have looked different. If I write a similar blog post in another 2 years, I will have learned more, and have new insights. We are all on a journey of discovery, of learning who we are in God’s kingdom, and of how best to serve our Maker. This post is my best attempt to share, out of love, lessons we have learned thus far in our journey, about serving abroad in His name. I pray that as each of us learn more and more about how God wants to use us for His glory, that we give each other grace to learn and grow in Him.