Dr. Paul Farmer

I have something (actually 'some things') to learn from this man. Tracey Kidder wrote a recent bestseller called Mountains Beyond Mountains, an oeuvre that describes (in part) the quest of one man "who would cure the world." An infectious diseases MD, he has spearheaded Partners in Health and has served extensively in places like Haiti, Peru, Cuba, Russia and Malawi. Ah, I get so excited and inspired when passionate people like him talk about global healthcare!

Dr. Farmer spoke at UW Monday night and I was able to go hear him via livecast in an overflow room. He recalled a conversation he had with a director of a national AIDS program in Africa who asked him, "Can you tell me how there can be 150 NGOs working in Rwanda on AIDS and they haven't even enrolled 150 patients for treatment?" Paul's response? "A lot of money is invested in the office in the capital city, in the vehicles, doctors salaries....not enough money is invested in patients." Amen, brother.

When asked how he juggles his priorities of global health work, patient concerns and his family, Farmer acknowledged "it's not an orderly process." When is life ever orderly, especially when working cross culturally?

He showed pictures of a man named John, who at once point was completely emaciated as a result of his health condition and has since been treated and now has quite a belly on him. People asked him if they could use his pictures and he responded, "Why don't you do your own 'before and after' project? Wouldn't it be great for once in your life to see someone go from 'skeletor' to needing 'lipitor'?" Ha ha.

Dr. Farmer discussed the fact that often people doing global healthcare do not have the tools to accomplish their work. He's "committed to using the fruits of science and technology...on behalf of people living in poverty...sometimes in the fight against AIDS, or TB, getting Malaria nets out, improving seed quality....always it will involve looking for clean water or getting kids primary school. And this is very difficult work. It's not glamorous to talk about all of these things at once. People don't rush and say, 'oh yes, let's go do poverty reduction.' We're looking for magic bullets still...unfortunately no magic bullet is going to solve the problems we see, not just in Africa, but also in poor parts of Seattle or Boston or New York...in parts of Asia...."

His parting advice for the students and others present? "Work for others who have greater needs than yourselves." He said, "Use what you learn to transform yourselves and your community," he advised. "Work locally or translocally, going back and forth between your home and someplace that needs your help." "I believe that the only way we can move forward and take on those problems is if we have a proper movement and everyone gets under the tent to fight for some of these basic rights."

What does this all mean for me? I think it would be a dangerous thing for me to become too comfortable or complacent in my current career path. I love oncology nursing and am facing plenty of challenges in the present, but, I can't help but think there is more. I can't deny this passion and calling to international healtcare. After being in Helene this summer where there is no doctor, I was confronted with what I lack when in comes to assessment, diagnosis, prescription, treatment, and follow-up. Frankly, it was often frustrating. I feel like in order to better help people in this way, I need to have a greater knowledge and skill base than I do now. What does this say about preparation? Do I go on to become a community health ARNP, family ARNP or something else? Only God knows where He wants to take me and He is where I must continually place my trust, hopes, and dreams.

Understanding her journey

Friday I was stoked come to work and find out that I would be with my new friend. She had a bulletin board full of pictures and told me about each person in each picture and the surrounding events. That got us on the subject of guy talk, which was fun to hear her stories. I had some time to ask her about when she was first diagnosed this past summer. I asked her what her symptoms were and she replied, "I just felt weak and tired all of the time. I started to look quite pale and was bruising all over. Every once and awhile I would just throw up, or feel like I was going to pass out. The doctor ran some tests and discovered I was extremely anemic. But it didn't stop there because they wanted to run a lot more tests. Two days later I found myself in the hospital and starting chemotherapy. Talk about a major life switch." She described the many ups and downs of Leukemia. Later in the day, I sat next to her as she told me about the hopes she has for her dad through this - mainly, that he would find God. That was a level we were definietly able to connect on. I asked her if we could pray for our dads, and we did. After that, I told her that she was an answer to prayer for me because when I started my job a few months ago, I prayed that I would be able to understand the whole journey that someone with a blood cancer has to go through. It wasn't until I had her that I was able to read her very well-updated carepages in their entirety and hear her many stories about having Leukemia. She has really helped me to better grasp what the day-in, day-out process looks like, even though I will probably never be able to fully understand.

memorable medical center moments

This post is in pink in honor of the patient I am about to write about. I was blessed to be with her on both Thursday and Friday this week. In gathering info. about her in report on Thursday, I learned that she's quite young and has an identical twin who donated for her stem cell transplant. In meeting her, she was tired but quite sweet. Later in the day, her friend ("other mom") came for a visit and brought home videos from when she was 16. They let me sit and watch for awhile as we laughed at silly, 16-yr-old behavior at various holiday parties and birthdays. I commented on her beautifully long and blond hair, knowing that chemo had taken that from her but that she will get it back. I asked about the different friends in the videos, who she said were now at Whitworth and Biola. Knowing that those are Christian colleges, as well as hearing Newsboys and veggie tales songs in the home videos, I began to wonder if she is a believer.

I came in later to take her vitals and she saw my badge, which has a "SPU Nursing" pin on it. She asked me, "did you go to SPU?" I told her that I graduated from there in June and she responded, "I was supposed to transfer there this fall from UW, but then I was diagnosed this past summer. But, my registration lasts 2 years so I'm still planning on going there. I want to be a RN or a dance teacher." (She's been big time ballet dancer since 3rd grade.) I asked her what made her want to transfer from UW. She said, "Well, the values of most of the professors and students I interacted with were really different from mine, and I really want to go to a Christian church." I asked, "Are you a Christian?" She said yes and asked me if I was. Her phone rang and I said "I'll let you get your phone, but I want to continue this conversation later." She said, "Ok, deal!" :)

When I went in later, her "other mom" had left and we ended up talking for over an hour (I had done everything to catch up with my other pt.s so we could talk awhile). Right away, we connected about Christ. "I am just in constant awe of God," she said, commenting on the many blessings in her life since being diagnosed with Leukemia. She talked about how her transplant from her twin didn't go as well they had hoped (she relapsed), so they are looking for another donor to do a second transplant. The cost of one transplant (just the cells) is $250,000.00. That is the maximum amount her insurance will cover. She said the costs, when all is said and done, will be well over 1 million dollars. She's been amazed at how many people have given money and sponsored fundraisers for her (such as her dance academy, church, and her old high school). She said although it's been really hard, she can't help but count the blessings and the many ways others have helped her and her family. Wow. We went on to talk about SPU and her dreams of becoming a nurse or teacher. She asked me why i wanted to be a nurse. We talked about her twin sister & the rest of her family. She told me that more than anything, she's praying that her dad will come to know Christ through all of this. She told me her testimony, how she came to find God. I asked her how I could be praying for her and she shared with me her online carepage address, which has consistent pray request updates. I asked her if we could pray right then and she said she'd love it. We prayed.

When I left her room, I went to see if she had a "primary" nurse. She does, but at that point, did not have an associate or "secondary" nurse. I signed up right away to be with her (meaning, I will automatically have her whenever I work if her primary nurse is not there). When I went to say goodbye to her for the day, she told me to "request me" for tomorrow. I said that's a definite. I am thankful to God for this new friend of mine. What amazing relationships and interactions I've been able to have at this job called nursing!

BEING a Nurse Means...

You will never be bored
You will always be frustrated
You will be surrounded by challenges.
So much to do and so little time
You will care immense responsibility
And limited authority.
You will step into people's lives
And you will make a difference.
Some will bless you,
Some will curse you.
You will see people at their worst
And at their best.
You will never cease to be amazed
At people's capacity for
Love, courage, and endurance.
You will experience resounding triumps
And devastating failures.
You will cry a lot.
You will laugh a lot.
You will know what it is to be human
And to be humane.

I'm not sure who Vanessa Kell (via the internet) is, but she put it well when she described what it means to be a nurse in this bit of writing.

I dream of Helene

Today my thoughts race back to Helene, as I am thinking of all of the wonderful people I met there. I am remembering a lot, but specifically, the days prior to leaving the island...singing “Because He lives" and praying with Sula...sitting on a log and looking out onto the clear blue Carribean with Joy as she tells me about what she hopes for the youth of Helene...speaking Spanish with Ruth as we discuss her baby to be...munching on sugar cane that Ewings brought us...successfully starting an IV on Alisa (after multiple failed attempts)...doing a digital block and then carving out the infected toenail on Jerry's foot...and laying out on the deck under the stars. What good times! Alisa and Deirdre just wrote me with a miraculous story of how God used them to save the lives of both a mom and her baby, who was delievered breach by these two most stellar missionary RNs! Thank God!

As certain memories fade quicly, on thing I do NOT want to forget is the island LINGO...Here’s some very technical Helene terminology:

· Alright and Okay: both acceptable greetings meaning either hello or goodbye
· Bra: bro or brother
· Hey, girl!: how ladies greet each other
· Drink pills: take medications
· Who is he / she for?: Who are his / her parents?
· Backin’ it: to carry a small child (or anything else for that matter) on one’s back
· Dorey: a small boat
· Hail: to beckon for somebody
· Monkey La La: a type of Iguana that can walk on water – AKA Jesus iguana
· Hogplum: type of tree outside the clinic
· Hogito: flavored frozen water in a sandwich bag, like a popsicle – mmm...
· Balliatas: Handmade tortillas with beans and cheese – the best burrito ever!
· Hubuggin’: Word for “bothering”
· Ush!: Gross!
· Molest: another word for bothering (not in the way we use it)
· *hit: it is what it is (not derogatory as it is for us)
· Pressin’: playing video games
· Joog: To cut or to poke (usually in reference to cutting open boils…sorry, that was graphic)
· Bile: boil (very common here and quite painful)
· Bathing in the sea: Swimming in the Caribbean
· The most, eh? The wickedest, eh? Strictly the best, eh?: Ewings’ phrases for “awesome”
· "Good enough for the girls I date," "Ya done know" (more Ewings)
· Angelina's 3-year old sayings: "Yes, girl" "No, mon;" "don't come by me!" (to larry); "the MAN!" (about Joe in his dive skin); "boom baby" (Emily taught her that); "my chocolates on your ba-ack" (after smearing it on Joe's shirt); "stop singing!" (to Camas); "jalisa!!!" (Alisa's name)
· "Wild savage" (our endearing term for each other, except for Margie)
· Yabba Dabba Ding Dongs: ancient artifacts found on Helene (seriously!)
· Bonky: rear end
· More crooked than a pig’s tail: Ewings’ saying for people (oh Ewings!)
· Plus, all words that start with “V” are pronounced as “W” (i.e. “vexed” is “wexed” and “vine” is “wine.” Sister Cheryl can be heard saying, "Abide in the wine!" My personal favorite, probably due to the fact that I grew up with older brothers: “veggies” is “weggies”.)

Alisa, if you read this, I'm sure I forgot something! Help! ;)

Things I do not miss include the 98-degrees-98%-humidity-you-don't-even-know-what-HOT-is-until-you've-done-Helene days and the ever-growing collection of mosquito bites on my extremities. Things I dearly miss are laughing (those missionaries are a hoot), meal times (Larry is an extraordinary cook), clinic, snorkeling and praying with people on home visits. God bless you all...you are not forgotten.

You are not your own

Lately, I've been reminded of how life is a gift - in both an earthly and eternal sense. Whew, I've seen a lot of death lately and it's a very difficult part of my job. Yesterday, I walked into the room of a patient who didn't make it (not one of my patients). Monday, I was confronted with the news that one patient who every nurse couldn't help but love had passed. A week ago, I went to a memorial service for a patient. It hit me pretty hard because it was the first patient who I had actually known face-to-face, even though I wasn't close to him. I had been in the room with him and his family during his transplant. He was quite young, had just gotten married a few months ago, and was a dedicated follower of Christ. The service was definitely a time to mourn over the loss and suffering he had to endure, but also a time to honor God and the life of this person. They did a good job of explaining his death as a "passing on" rather than a "passing away." Praise God for that. It was inspiring for me to hear about how he seized and appreciated just about every moment of life. How often do I take my health, blessings, and simply my state of being completely for granted? The times would be too numerous to count. These patients are teaching me so much about perspective, even in their passing.

You are not your own; you were bought at a price. Therefore honor God with your body.
-1 Cor. 6:19-20

More on prayer...

A friend of mine from Tabitha wrote the following, something I resonate with, something I'd like to remember...

"Hidden within me is a heart that is reluctant - even fearful - to be with God in prayer. When I set aside times of silence, prayer does not come easily for me, or at least not as easily as anxiety, self-condemnation and pride. Why is it that our times of solitude and searching after God seem to arrive more often at emptiness than the promised embrace? If I show up, will He be there? And if he is there, how will he respond to my exposed heart? My fear of such raw questions causes me to maintain my distance, and thus my spirituality becomes duty, discipline and productivity - anything but intimate encounter...

We are good at having a sense of obligation - we are even better at self-condemnation - but somehow have lost the sense of invitation that might be the crux of Jesus Christ. God has come to us. Will we come to him? As we come, stumbling and unsure, I believe he will teach us how to come. For as unique as every heart, there are many ways to enter prayer. Prayer is a cry of desire. It opens ourselves to relationship while claiming the courage to traverse doubt, see our nakedness, and await a Presence we cannot contain or control. How God shows up is not our agenda. The Scriptures, lest we forget, reveal a God who dwells among us most unpredictably. He shows up according to his plans, teaching us in both absence and presence. But will we come? And if we find only our famished souls, will we praise him for that, too? Perhaps he is exposing hunger, even while preparing a banquet table.

May our prayers be used by God to teach us how to be with him, laying aside expectation and simply responding to Christ - the incarnate invitation."

Amen, Kim!