Changes

     For the past several months I have been wrestling constant exhaustion and persistent feelings of sadness. I had hoped that my time in the States wold be a time of refreshment and preparation for 2015. Instead, I left the States more exhausted, more spiritually and emotionally wrecked than when I came. Several weeks of intense prayer and tearful conversations with those whose counsel I trust have led me to decide that it is time to pursue next steps in my life.
     Effective February 16th, I am stepping down from my responsibilities at MOHI and returning to the States for some spiritual and emotional care. Life in Haiti is unrelentingly harsh and as much as I love it, this isn't the place to be when I'm already struggling. (I want to be very clear about what this is not. This is not about any sort of falling out between myself and MOHI, or the Edmes. I still count them among my dearest friends and have every hope of returning for at least short term visits in the future.)
      Frankly, this is one of the scarier decisions I have ever made. All my life, all I've wanted is to live overseas in a ministry setting. I'm not really sure who I am without those things.To those of you who have been so faithful to join with me in prayer over the last few years of cross-cultural adventures, I ask that you would continue in that. I deeply believe that the MOHI clinic is a work of grace and the Spirit, and that as such, it will continue on. That being said, I'm leaving large chunks of my heart behind, with the clinic, with my friends, with a couple of half-grown teenage boys. My head knows that this is the right decision for me, for now. My heart is having a hard time letting go.

Anse-a-Pitre

         A four and a half hour drive into the mountains yesterday landed us in Anse-a-Pitre, where we held a community clinic. This was our first time in the area, and the people of the community demonstrated their gratitude with hand carved wooden plaques, thank you notes and a sumptuous meal. Their generosity made the bumps, jostles and headaches worth it.
       For obvious reasons, I spend a lot of time thinking about cross-cultural interactions, the ways the different kinds of poverty manifest themselves in different cultures, and the ways in which Westerners in general and American Christians in particular reinforce stereotypes and assumptions that worsen the respective kinds of poverty for both my Haitian and American friends. A repeated example of this is when Americans visit Haiti, are overwhelmed by the material poverty and make the mistake of thinking that because of their material poverty Haitians cannot do things for themselves. Whether it's getting to the clinic, or feeding and dressing their children adequately, we as Americans often assume that because our Haitian friends and acquaintances do not have access to the abundance of material goods that we do, they have less to offer in our cross-cultural relationships.
     The longer I am here, the more vehemently I disagree with those assumptions. I am brought up short again and again by the beauty of my Haitian friends' hospitality. Yesterday was a perfect example. When my American eyes looked at the situation my patients were in, I am tempted to think that because they apparently have so little, they do not have much to offer. That's a false assumption. Yesterday I saw a community working together to seek treatment for their sickest members, young men and women assisting in the organizing and flow of the clinic, pastors advocating for those that needed it. I community in action.
     The longer I live in this country, the more I learn about what generosity and living as brothers and sisters in Christ can look like done well. My Haitian friends have unique gift and talents to bring to the table of Christ that make all of us richer. I was (am) hesitant in posting this, for fear of the myriad ways I could be misunderstood here. This is not a "they're poor, but happy" post. I have spent too much time one on one with patients in the clinic to ascribe to that theory. My friends and patients are acutely aware of the ways in which their material lack makes their lives harder than their Western friends' lives, but that isn't the whole picture. My friends bring something beautiful, rich and deep to the table of Christ and I don't want that overlooked or missed in any way.  I pray that in my time here and abroad as I share about my experiences, in word and in deed, I would learn to do them justice.

Bless Back Clinic

    We have a Bless Back Worldwide medical team working alongside our staff this week, providing patient care and community health teaching. It is always a joy for me to work with our partners at Bless Back towards our shared goal of high quality, dignified healthcare for all of our patients. The first few days in clinic have flowed incredibly smoothly, for which I am exceedingly thankful.

The triage and intake area, where we check patients in and take their vitals.

Becky and Ancitho providing medicine teaching in the pharmacy.

Nurse Matha and Student Nurse Baby checking vitals as patients wait in line to be seen.

It's hard to be still for a length check when there are so many interesting things to grab at.

So thankful for our dental team!

Everyone was charmed when this precious girl spent the day grinning at us. 

     In the midst of clinic weeks like this, with so much going on, I often find myself becoming ultra task-oriented, caught up in completing the next thing that needs to be accomplished, or untangling the latest snafu. It's easy for me to get so harried in managing the administrative tasks of keeping the clinic running that I forget to really see the human beings in front of me. I don't love this fact about myself.

       Yesterday, I ran across the excerpt Prayers for a Privileged People by Walter Brueggemann and it resonated deeply.

"Give us some distance from the noise,
some reserve about the loud success of the day,
that we may remember that our life consists
     not in things we consume
     but in neighbors we embrace."

Let it be to me Lord. Amen.

(Thanks to Melissa Roper from Bless Back Worldwide for the clinic picutres.)

Coming back

        Back to Haiti means back to daily drama and regular reminders to count my blessings. It means back to patients recounting stories of children they've lost and newlywed parents facing the loss of a child. It means daily reminders of all the complicated ways poverty assaults my friends and loved ones.
     Back to Haiti also means a three year old running across the yard, arms flung wide to greet me with a hug. It means MOHI students calling my name, telling me how the haven't seen me in a long time and how much they missed me. It means a 17 month old in our nutrition supplementation program who was fussy and undernourished six months ago toddling around and grinning wide on his follow up visit. It means welcome hugs and the overwhelming beauty of Haitian hospitality.
     In the storm of emotions that was my first week back, the clinic and I received some particular blessings. On Tuesday we were given several tote-size boxes of medications from friends in Gressier. Our whole staff celebrated when we found boxes of medicines we had been running low on!

Nurse Ruth and I were thankful for Liz and Lina's help sorting and inventorying our new supplies.

     As previously mentioned, I also have a beautiful new bedroom and bathroom. Two windows make for a welcome cross breeze and new shelves provide me lots of space for my beloved books and handmade art projects from the kids!

     
      For those who've sent prayers and supportive emails and Facebook message as I've transitioned back, you're the best! I cannot overstate how welcome they were. This cross-cultural life can be intense and your support is a gift. Thank you.
     

     

5 years later

       I got back to Haiti on Thursday, and (no surprise here) it has been a whirlwind. We had our annual leadership conference this weekend and over 500 participants showed up to our guesthouse the first morning for teaching and workshops. Things were beautifully crowded. On a personal note, construction has been completed on my beautiful new room. I hope to get pictures up in the next week.
      Today, however, is not the day for those stories. Today is the fifth anniversary of the earthquake. It is a day for remembering, for prayer and for reflection. It is a day for mourning the brokenness that is still present while shouting the hope the continues breaking forth. Join with us in remembering today. Light a candle, if that's your thing. Take a moment to pray, to reflect, to grieve and to hope. I know I will.

Goodbyes with the preschool

       I got to the clinic a few minutes early this morning, which meant I was able to spend some time with our preschoolers as they gathered in the yard for singing and dancing. The teachers all know I'm leaving tomorrow and wanted to take some pictures, so we huddled together and started clicking away.

It took some coordinating

And some negotiating

But we finally got it. Mostly.

I'm going to miss these precious faces when I'm in the States!

Out with a bang!

      This will be my last week in Haiti for 2014 and I'm going out in a rush of activity. The last several weeks have been a flurry of training for my staff as I prepare to leave the clinic in their hands while I am gone. We have been practicing communication and teamwork as we all figure out how to fit together. I have been training them on our computer charting system and inventory practices, as well as our protocols and individualized patient education expectations. They have done a wonderful job asking questions, practicing flexibility and absorbing an enormous amount of new information in a short amount of time.
       Since I am leaving Saturday, this week is our trial run where my staff begins to operate without me. I wanted them to have a few days where they were working without me hovering, but where I was available for any questions or concerns that arose. Today was our first day and I was pleased with the results. The MOHI clinic has become my baby, but I feel optimistic about leaving it in their capable hands.
      We also have a team from Bless Back Worldwide this week doing well child checks on all of the nearly 800 children in our schools. Somehow a rumor got started among the elementary school that the team is here to give them all shots. Things went more smoothly after we clarified that this was not the case. Along with head to toe check ups and deworming, the team is teaching our students about proper sanitation and the importance of keeping their living environments clean. After the teaching and check ups, each student is receiving a water bottle to carry with them and encourage them to increase their hydration during the day. Hurray hydration!
      Will you join with me in prayer over the next few days? Will you pray for the Bless Back team as they continue to work incredibly hard to see all of our kids? Will you also be praying for my staff in this time of transition- that any questions would be answered, any snafus would be untangled, and any anxiety (mine, for instance) would be soothed? Thank you!

Baptism

      We had a baptismal service yesterday after church. Church members came by foot, by car and by motorcycle. They gathered at the beach behind our guesthouse property to pray, sing and bear witness to these holy moments. The baptismal candidates, many of whom were from a local orphanage with an extensive history with MOHI, came outfitted in white.
     After individual prayer and guidance, the candidates were immersed. In pairs they rose up out of the water, smiles radiant. As they broke through the surface, droplets of water glistened in the sun and I stood in awe at the new life happening in front of me. Waves threatened to knock one girl down, until she was steadied by one of the baptizing pastors who also acts as a father figure in her life. When they returned to shore, the newly baptized were welcomed with towels and smiles into the arms of their church community.  Baptisms always make me cry, but this one was particularly beautiful.

Two years in

       In a little over two weeks, I will be wrapping up my second year living in Haiti. Being me, I have feelings about this (having feelings is one of the things I'm best at doing). Two years ago when I was getting ready to embark on this adventure, I thought that if I could just check all the boxes, I could be prepared for what was coming. I think a part of me knew there was no way to really prepare for what was in store, but I tried. I read books on missions and development and what it means to do those things well. I listened to podcasts and sermons and prayed my little heart out.
       Then I got here, and it's been more than I could have dreamed. If you had told me at the end of October 2012 that in under two years, I would be running a clinic (with a staff!), I would have laughed you off. Yes, I dreamed of those things, but I didn't dare hope that my dreams could really happen. I didn't dare hope to find a mission with like minded people I could respect, work with, and when necessary submit to. I didn't dare hope that educational programs could be started. I definitely didn't dare hope that the first nurse we hired would be dedicated to learning every possible thing she could in order to better her professional practice.
       I was reflecting this morning on how deeply grateful I am for the last two years. They have been hard, enormously hard most days, but they have also been incredibly rich and beautiful. I have a group of coworkers I can laugh with. I have learned to make jokes in a second language. A huge chunk of my heart is now walking around with a couple of half-grown, moody teenage boys. I have been challenged, stretched and grown in a myriad of ways. My thinking on the kingdom of God and faith in general is more nuanced than before.
     As I start dreaming for year three, I am so incredibly grateful for the time I have spent here and cannot wait to see what 2015 holds. To all of you, who through prayer, finances, Skype calls and emails have made this thing happen, thank you for your support. As this communal culture continues to teach me, I couldn't do it without you!

Our new staff

The Doctors Lavaud, a married couple, split the work week between them as they hold down other positions as well. I appreciate their gentleness and patience in teaching patients.

Nurse Ruth consistently seeks out opportunities to learn new things in the clinic and jumps right in to help with any needed task.

 

Introducing our new MOHI clinic staff:

         Having a staff meant I got to spend some one on one time with this chickadee yesterday, convincing her to take her worm medicine. Yes that is a lollipop in my hand. Like Mary Poppins, I believe a spoonful of sugar helps the medicine go down.

      In unrelated housekeeping news, I fly to the States in a little under three weeks and will be there until early January. I'll be traipsing around Florida. Let me know if you want to get together!

Enough

     Last Sunday I listened to a sermon about how the Lord uses us in our weakness, how coming to the end of ourselves can be a redemptive thing when it allows the Lord to work in our lives. After listening to it, I basically thought to myself "well, that's nice" and filed it away for later.
      Later came faster than expected. In the space of a week I have gone from running the MOHI clinic on my own, to having a staff. Suddenly tasks are getting accomplished faster and I am having to learn to manage personalities in a culture that is not my own, in a language I still wrestle with. More than twice I have wondered when everyone was going to catch on that I am not enough for the task at hand. Not smart enough. Not strong enough. Not culturally sensitive enough. Not experienced enough. Not tall enough. Not enough.
    The thing is, all of those things are true. I am not enough for the task at hand, for the dreams that are being spun for the MOHI clinic. Left solely to my own knowledge and experience, I will make an utter mess of this thing that is so precious to me. Which I why I have been enormously grateful not to have been left to my own devices this week. There has been the grace of an international network of experienced health professionals to refer to for the program building. There have been people with more experience and insight into this culture than I have to talk me through laying a foundation of professionalism and respect for my new employees.
     More than anything, there has been the grace of me, on my knees before my God, begging for mercy as I negotiate these changes, begging for the grace to know how to proceed. Would you continue to join me in prayer for the MOHI clinic and the major and exciting changes we are making? Pray that we would work in unity for the good of our friends and neighbors, that we would learn to communicate and fit together well, that we would glorify the Lord in our thoughts and actions. Thank you.

Welcome Dokte!

     After a roller coaster week of decision making and interviews, I am terribly excited to report that we have hired a doctor for the MOHI clinic. Dr. Miche Lavaud was born in Haiti and educated in Haiti and the Dominican Republic as a physician and an ultrasoud technician. He has several years experience working in both countries in hospital settings and speaks Kreyol, English, French and Spanish.
    Part of the vision of the MOHI clinic involves working respectfully within existing health systems in Haiti. Among the assets that Dr. Lavaud brings to the table is several years experience working in Grand Goave's local hospital. Dr. Lavaud's experience and connections open doors for our clinic to expand our level of care and assist our patients in further fulfilling their healthcare needs. Today was his first day on the job and he is already setting up personal appointments with patients to help them get needed surgeries. Welcome to the team Dr. Lavaud!

Update from the clinic

       We spent this week dreaming for the MOHI clinic, weighing options and weighing next steps. We look forward to the days of a fully Haitian staffed clinic and strong community health programs and have been looking at how to implement those goals. In looking at our options, we have decided that next steps for the clinic include hiring a Haitian physician and nurse to work alongside us.
       There are several reasons we are excited about these next steps. For one thing, having Haitian staff helps affirm the dignity of the patients we serve. Haitian healthcare workers are already familiar with language and cultural nuances and needs, and can bring a depth of insight into patient care that would take me, as a foreigner, years to match. The other exciting point about increasing staff is that it frees me up to pursue building up our community heath programs. Having Haitian medical professionals gives me more time to pursue programs, and more resources to partner with as we work together to develop health related classes and try to develop a more community based role for the clinic.
          Hiring a staff takes money. I don't love asking for money on this blog (or really at all), but for this I will. We are developing a physician sponsorship program where people could donate monthly towards the cost of paying our doctor. If that is something you would be interested on, please contact me. Beyond that, will you continue to join me in prayer for the MOHI clinic in this decision making and transition time? Thank you!

Sometimes

      I have written before about how I am learning to lament this year, gaining practice in grief. Sometimes (most times) that grieving comes from being here. It comes from the patient who refused to be compliant on his TB medication and died, despite all our efforts at intervention and education. It comes from the woman who comes to the clinic with a massive breast mass and almost no treatment options. It comes from the daily hurts of systemic injustice. I counted the cost of this kind of grief when I came  to Haiti. I expected it. I prepared for it.
     It turns out there is another kind of grief, the grief of not being there. This grief crashes down when the people I love more than almost anything are wading through hurt and our contact is limited to Skype, Gmail or Facebook. Modern technology is an incredible grace in allowing me to remain connected with loved ones in the States, but it does not replace sitting on the couch and sharing the hurt with them. I am nothing if not a nurturer and I was not, am not prepared for the grief of not being present. This grief leaves my heart small and shivering, to borrow a phrase from one of my favorite novels. My closest friend is walking through heaps of pain this year and I hate, hate, hate being so far away. I would give almost anything to be able to sit with her in her tears tonight. Since I can't be there with her in person, will you join me in praying for her as she hurts?

Prayer Request

     I have had a cold this week, which has left my head floating somewhere above my neck, barely tethered. This makes stringing sentences together in English difficult. Let's not even talk about my Kreyol language skills the last few days.
     As I have mentioned before, we are looking into major changes for the MOHI clinic. Things have been absurdly busy in the clinic for months and we are in the process of trying to figure out what our next steps should look like. We are looking at how to wisely implement opportunities available to us in the best interest of our patients. Join with us in prayers for wisdom and guidance as we figure out what the next few months will look like? Thanks friends!

Oral Rehydration Corner

                Yesterday's clinic experience was a veritable parade of mamas making wonderful choices for their children.We had mamas bringing their kids in for follow up appointments (more a of a rarity than we would like), mamas advocating for their babies' needs and mamas working with us to help rehydrate their sick toddlers. I was fairly dancing by the time clinic ended, a rarity for Monday.

One of the things I see fairly often in the clinic is children under five years old with diarrhea, a major worldwide killer. We have implemented a set of protocols for treating these children that follow WHO recommendations. Part of these procedures involves keeping children with some dehydration in the clinic for a couple of hours, to orally rehydrate them, and assess whether they are stable to go home. This procedure gives us (hopefully) a four hour window with these children and their caretakers, a great opportunity to chat and teach. At least that's the theory. In practice it is difficult to convince caretakers to stay for the entire time and I am often left giving instructions for home care, a much less preferred option. We had a little girl in the clinic yesterday who fit the criteria for some dehydration and I asked her mama to stay with us for a bit, so we could give her daughter the fluids she needed. The mama, to my very great delight, agreed.

 In an effort to keep little ones from going stir crazy in the clinic, and to encourage the caretakers to stay for rehydration therapy, I keep some educational activities around for them. Yesterday I shared a coloring book and a book with the alphabet in it with the mom and her daughter. After explaining what I needed from the mom, as far as giving her daughter frequent sips of fluid, I left them to themselves to see my next patient. Within a few minutes, I heard the mom singing the ABCs with her daughter and her daughter trying to sing along. This continued off and on for the better part of an hour, interspersed with drink breaks, where the mom managed to turn getting the needed fluid to her child into a game that keep the little girl drinking plenty and often, exactly as we like it for dehydrated toddlers.. 

I'm not sure if I can express strongly enough how beautiful the whole thing was to watch. This mom who had been desperately worried about her daughter, singing and playing with her just a few minutes later.The little girl who came to the clinic droopy and left with a bounce in her step. Some of their friends who were in the clinic line, who celebrated with the mom over her daughter starting to look better. I was left marveling again at the beauty and strength in this incredible country.

School Nurse: Year Two

        As I mentioned in previous posts, school started back up at MOHI about a month ago, which meant I resumed my duties as school nurse. I have written before about some of what it looks like to act in this role, but things have changed a bit in how I relate to the kids as we start our second year together. Last year was a time of getting acquainted with one another. This year, we are working off of that foundation, which can be a lot of fun.
      Working off of that foundation means there's a first grader who stops on her way to lunch to fling her arms around my waist and proudly announce that she drinks lots of water. (I am forever telling the students that drinking more water will help heal near any ailment they come to me with.) It means there are twin preschoolers who jump up and hug me every time they see me. It means the teacher for our youngest preschool class brings a group by the clinic on a tour of the school, to introduce me and tell them they do not have to be afraid of seeing me
       It means welcoming teachers back, and rejoicing to see how they work with their students. It means birthday crowns in the preschool and singing and dancing in the yard when I arrive to start clinic. It means clinic consultations happen at a slightly higher volume because of the lectures going on in classrooms. It means a line of kids in the clinic in the afternoons, coloring and reading books and talking to me about what they see in the books. It means discussions on hand washing and trash disposal and tooth brushing. It means smiles and cheers and bustling activity. It means a continual influx of new reasons to fall in love with this country.

Recounting Charlotte

                Last week was a whirlwind of meetings and family time and all kinds of grace.  I flew to Florida a week ago Saturday and to Charlotte last Monday. While in Charlotte, I met with Lex and Renee and various people from Bless Back International to discuss clinic matters, or as as I like to call it, the state of the union. 

                The meetings in Charlotte mostly involved discussing next steps for the MOHI clinic. It was a time for spinning dreams and what-ifs and what-nexts, for weighing opportunities and finding ways to improve and expand clinic services. More on those things as they develop. Usually when I am with the people from Bless Back, it is in Haiti and we are running full speed ahead in the clinic, so the chance to enjoy one another as people was welcome.

                The second major blessing of last week was seeing the Edmes. Well, most of the Edmes. They have been State-side since the beginning of August, making this the longest stretch apart since I came back in January. One of the more bittersweet aspects of them being gone has been how much I have missed spending time with them. We work well together as a group, but in a tremendous grace for a group who spends as much time together as we do, we also enjoy one another's company. I mean, I am assuming they enjoy mine. I certainly enjoy theirs. Last week we moved the party to Charlotte and laughed over every ridiculous thing we could think of.

               Speaking of laughter, I sandwiched the Charlotte trip with weekends at home with my family and best friend. When we are together, I laugh until a cry, until my sides ache and I cannot breathe. The grace of being surrounded by people who know some of the deepest, rawest parts of me and love me anyway is almost more than I can take in. When I am home with them, I am absolutely saturated with love.
               

                

Charlotte

       I head to the States tomorrow for a quick trip to Charlotte by way of South Florida. I will be meeting with the Edmes, and people from Bless Back International, MOHI's main medical partner. I checked the weather for Charlotte, and apparently it's supposed to be in the 50s at night. So I will most likely freeze death in the next week. Assuming that doesn't happen, I am beyond excited for a couple of days with family, friends and hot showers. My internet connection took the week off without my approval. Now that it is fixed, I am madly scrambling to get things caught up to fly out tomorrow, so I will leave you with this picture of one of our preschoolers today.

Learning to live here

"If you have come here to help me, you are wasting our time.

But if you have come because your liberation is bound up with mine, then let us work together."

Aboriginal Activists group, Queensland, 1972

 

            I stumbled on this quote on a global health forum this week and it resonated deeply within me. I (naturally) spend a lot of time thinking about cross-cultural interactions and what it looks like to live well in a culture I was not born into. When I look at Haiti, I see a lot of damage done by well-meaning foreigners. We look at this country and decide it is broken, and since our way of living in our country works for us, we decide that this country needs to live like us. Consciously or subconsciously we assume that our way is the only right way to live. We miss (or misunderstand) the complex and wildly different history of this country, and more importantly we don’t see the beauty in how this culture functions. We don’t speak the language, or we don’t speak it well. We misinterpret interactions and we don’t listen or learn much. Instead, we impose.

                        I think there are two main ways of interacting with a foreign culture. One is the way mentioned above, bringing in the things that work in our culture and assuming if those things were just done here, this culture would be “fixed.” Few of us would phrase it so baldly, but our actions betray our underlying assumptions. This is the way of belittling our brothers and sisters in words and in actions, in snide jokes and muttered asides. We see the material comfort of our country and assume that our way is the only way. We see different as wrong, and in our attitudes and words belittle differences in others’ ways of doing things. This does so much damage to both sides. So much damage. It harms the people we are supposed to be working with, telling them in so many words, that they are less, and it harms us as pride and superiority, attitudes completely contrary to the Gospel, root themselves even more deeply in our lives.

            There is a second way. This way involves humility and listening and learning to see the value in the way another culture operates. One of the things I love about working with MOHI is talking to Renee. Renee has an incredible capacity to see the richness in Haitian culture.She sees beauty and strength rather than only weakness, and she celebrates what she sees. Moreover, she celebrates with me as I learn to see these things too. So many times I have come into her office to talk about something I witnessed, trying to process my thoughts. Over and over she has helped me see how the people of Haiti bring something unique and valuable and necessary to the kingdom of God. I believe that this is the way of peacemaking, the way that brings the healing that all of us, American and Haitian desperately need.

            Writing this post has been a bit of a “get the plank out of your own eye first” experience for me. I am leagues from getting this right. I spent the last week beyond frustrated with the way some systems work in this country, and to my shame mouthed off to my Haitian friends about it more than once. By the grace of God, I am learning to see. Grace opens my eyes to my complicity in the brokenness around me, and grace opens my eyes to the kingdom of God- a bigger, richer, more beautiful thing than I could have imagined on my own.