The Servant

Ethiopia, Kenya and Freedom

2011-07-08T18:56:00.000-07:00

So I take about 2 months between blogs, ... what's it to ya. Been catching up on my reading, ...moving Jule into her new digs on Temple's Campus...spent 4 weeks out of the last 8 on airplanes.....its been a busy time. In fact, 2 of the 4 weeks on the road were spent in Ethiopia and Kenya. Told my wife I'd be home for a while. She didn't believe me,.. and rightly so. No sooner than the school year ended, I was invited to join a team traveling to Ethiopia and Kenya to assess 3 hospitals for the Pan African Academy of Christian Surgeons. This is a training program aimed at reducing the "brain drain" of surgeon from these 2 countries so in need of retaining well trained medical professionals.

So there I was in Soddo, Ethiopia, Bomet and Kijabe Kenya.... On and off planes, little or no sleep, a plethora of lodging accomodations and unreliable electricity, but then I'm not complaining,...No need,....I live an amazing life,.. I get to go where I want, when I want, with whom I want,.. talk about freedom,.. GSK was never like this. But I wonder,.. is the freedom that all of us have, worth the cost, or the trauma of what is revealed to us. Freedom indeed has its costs,.. freedom to use our resources, freedom in how we spend our time,.... We are allowed to witness many of the horrors of life, horrors we see everywhere,.. if we keep our eyes open,... and sometimes,... even if we don't.

David was following the medical team from bed-to-bed-to-bed,... head cradled in his hands, ... a look of despair that 100 family deaths would be unlikely to rival. But this man of about 35 was following us as we made medical rounds at Tenwek Hospital in Bomet, Kenya as if his life depended on it,.. and in large part, it did. His wife, mother-in-law, and three of his children had been in an horrific road traffic accident. These individuals represented David's life. They were traveling on a bus that had overturned and collided with another vehicle causing several fatalities. In order to save their lives, David's wife, mother-in-law and two of his young sons needed left arm amputations, and the other son, about 3 years old, sustained a severely mangled left arm and hand. And David, who was not traveling with them, .. well,.. he gets to watch his loved ones suffer through this tragedy. But David is suffering too. What do you say? What is there to say? Freedom has its costs. We can seclude ourselves in our homes and offices, (or Churches for that matter), or, we can be with David. We can suffer with him. We can pray with him and for him. So the question, I suppose is,..do we want that kind of Freedom?

Road traffic accidents in Kenya are the leading cause of death in that country. David and his family are just one example of the traumas of this daily experience suffered by so many. On the way to Tenwek for example, we witnessed a car that had careened through a guardrail down a raveen of the Rift Valley. ... A daily occurrence for David and so many others. Add this to HIV, malaria, tuberculosis,.. you get the picture,... a recipe for disastrous quality of life anywhere on the planet.

If we choose to use our freedom of taking the poor into our hearts,.. as they suffer, it will cost. As our hearts aches, can we handle the pain? David's heart needs to be held by ours.

Vulnerability,.." I'm Joe Pitts"

2011-05-07T23:04:00.000-07:00

Been a longtime between blogs,... but life has been hectic in recent weeks, professionally and personally. Its taken me to L.A. this week to visit with my Uncle Joe, my Dad's youngest brother. Visiting here with my brothers Derrick and Isaac trying to help Uncle Joe with personal and relational affairs, but far be it from us to help this active, independent and autonomous, in spirit anyway, 90 year old with anything. Still, he's showing signs of decline as many 90 year olds do and its hard to witness the slow but steady and certain reduction of autonomy, and, I'm sure, far more difficult for him to release it.

"I'm Joe Pitts", he defiantly stated during our somewhat hectic exchange that had included a visit from paramedics responding to the alarm that mistakenly was triggered by his medical emergency "necklace" while bathing. I had expressed concern, as had his children, that he might fall while trying to maneuver in the washroom. "I try to tell everyone that I'm not going to fall. "I know how to fall without breaking my hip. " I'm Joe Pitts."

It was in that moment that I understood, the horror for this 90 year old man, who was faced with the decline of his own mobility. It was that vulnerable moment that shouted the palpable fear he must feel that others must come to his rescue when confronted with weakness in what had been a strong and free life. How strange it must be for him to release his grasp on independence, to appear weak,... to appear less than able. What must this say about him? Can we even begin to imagine? My soul screams NO!...But in the sadness and joy of this sharing this moment with my Uncle Joe, my heart says we must.

Earlier in the evening, he had asked me how I was doing. I responded that I was doing ok, with the usual aches and pains of an old guy. Knowing I was talking to a 90 year old and that he would laugh, he predictably snickered that I didn't know what 'old' was. He and I actually have a good time together and can talk jokingly about such matters. But he was right, of course,.. given the context of the moment, I don't know what old is. Then as if to underscore this conversation and give me some hint,...some brief tutorial and preview, the episode with the emergency squad happened. The Universe does indeed have a sense of humor....and the joke's on us.

We stare at our vulnerability constantly. If we're lucky, it smacks us for our attention, and shows only brief respites between screams of our names. But classically, we deny our eventual demise, seeking immortality in materialism, perishables, children, family, even as we ourselves perish. Not that this is bad, but the key might be not to let these things take precedence over our consciousness about where we're going. What is our path and where is it taking us? How do we handle that ultimate anxiety, our vulnerability.

Joe Pitts is not unusual, I bet. Pushing back at vulnerability is a ubiquitous, human condition. None of us wants to feel weak, or unable, or afraid. But we are all of these things.

Several months ago, through events I'm still struggling with, I came face-to-face with my vulnerability and mortality. Its not pretty, but I'm thankful for these events..... my rude yet very much needed awakening. So I'm one of the lucky ones. But so are we all. If we are already paying attention and sensitive to our vulnerability, the awakening, can be reduced to just a reminder. A reminder that our lives can change in a moment. a moment that can cause dramatic renewal, a moment that can bring about enormous clarity. A moment that can birth understanding... even if the birth is that which you need to understand and explore further. On the other hand, if you're not paying attention, .. well, its time.

Paying attention to your vulnerability is not necessarily a bad thing.... it will change your life.

So, the next time you feel frail or vulnerable, weak and afraid,..clinging to your independence and autonomy,..the next time you feel close to your vulnerability, you might think of your Uncle Joe..... I do.

It ain't all bad,..... looking at our healthcare blessings

2011-03-24T09:43:00.000-07:00

Had an MRI today,... yep, .....laid down,... I.V inserted.,.. mask,... slid in the tube,.... the works,.. takin' a look at the ol' noggin,.. makin' sure everything is stable in there (and all without Ativan). Of course, this is a great time for me to be analytical,.. or is it critical,.. of the health care system as we know it.

If your in the waiting room of a hospital radiology department, or another department for that matter, ..seems that confidentiality is non-existent. Of course, this is a key tenet of HIPPA. But all those in the waiting room this morning know each other's names, .. not by exchanging pleasantries with each other, but by having our names shouted by the receptionist, when it came time for us to register. If you listened carefully, you could find out ages as well,... just do the math when the patients birth dates was asked,.. all in the waiting area. No big deal to many, but suppose the patient, well,... just doesn't want that information known.......Too late for that,.. I think "the cat is out of the bag". The background music, if there is any, just won't compete with the volume of the receptionist pleasant and dulcet tones :-). Oh, by the way, no curtains or private areas once your actually seated and talking to the registrar in the cubicle, so better talk in hushed tones if you really want privacy. But I say, it would probably be more honest if they use mega phones,... Sorry,... getting a bit cynical.

But even the skeptic in me admits that these individual sit and toil daily in order for me to have access to technology that could save my life. We often sit in judgment of the broken system that defines health care these days, but the individuals in the system are really doing a yeoman's job at being the glue that bond us to this system. As broken as it is, it works. Slowly at times,.. cumbersome at others, and more frequently than not, its frustrating. But it saves lives. And as much as we complain, our health care system has the power to deliver services that can't be found anywhere else in the world. The registrar in the cubicle provides entry to these services. I'll have at least some clue of what my tomorrow will be, or even if I'll see tomorrow because that registrar let me through the door to some of the most advanced technology in the world. So there I was in this tube called an MRI, for 30 minutes, my anxiety lifted and,... I took a nap. An over simplification? Maybe. But I thank this broken system and the registrar who told everyone my name and age, for allowing me through the door. Most of the world can't say that.

And there's more. After we were done (me and Tonto), we walked a mile,.. not on the track,.. not at the gym on the treadmill, but in the hospital. This hospital has arrows on the floor of their corridors, that actually mark off mileage,. a pretty cool thing. You can get an MRI and walk a mile,.. or two, afterward.. They're moving toward full service, one stop shopping in health care if you ask me.

So the next time you're tempted to complain about the U.S. health care system, stop and think. You have access to a system that, simply by being born here, insures that you get your three score and ten (if you want it),.. and often, more. And if that doesn't cheer you up, next time you're in a hospital, if you can, get those endorphins moving by going for a little walk.

Gratitude,.... now that's what I'm talkin' about

2011-03-18T03:16:00.000-07:00

Michael Bernard Beckwith talks about gratitude in an infectious way,... kind of makes you want to go out and catch whatever it is that he has. What do you think? Read on:

"When I first wake up, I wake up in a field of gratitude and thanksgiving. I’m just very grateful to be awake and aware and alive, in an attitude that allows me to see differently. When I’m in gratefulness, when I’m in gratitude, then I can’t vibrate on worry, doubt and fear. And I cannot live in the future as well because gratitude is now.

"So that’s the first thing I do. And then I will say something along these lines: “I’m available to more good, more love, more wisdom, more knowledge, more joy than I have ever realized, experienced, imagined before in my life.”

"I throw myself open by saying that.

"I’m now available to more good, more love, more peace, more joy – whatever the qualities are that I’ve ever experienced, realized or imagined before in my life – so, I’m on now a precipice of becoming more myself. So, I’m not living on yesterday’s laurels.

“I’m available to more good than I’ve ever imagined to come forward in my life and I’m not under any delusion that I know what that good is!”

"I’m not under the illusion, and I haven’t defined what that good is. I’m just available. I’m grateful and I’m available. Now, transformation can occur.

"And we always know it’s transformation because it surprises us – and if it doesn’t surprise you, it’s not transformation. It could be something that you’ve expected and put together in a nice, little, neat package.

"But when you throw yourself open by asking empowering questions and by willing to be more than you’ve ever thought you could be, you get surprised by the depth what’s inside of you!

"It’s so potent that it’s oftentimes shocking.

"You have to be prepared to free flow – what I call “free fall” – and surrender to the good that’s beyond what you can even describe. And so, a lot of the spiritual work is really about moment-by-moment preparation, to release the illusions of what you think makes you happy, to move into being a giver and a sharer of the Divine."

Re-arranging the furniture?

2011-03-12T07:26:00.000-08:00

So,.. if the Japan earthquake and consequent tsunami happened just around the corner, just how connected are we? I've been reading about geologic matters recently,... you know, plate tectonics, subduction, convergence, divergence, continental and oceanic drift and all of that. Turns out that our globe is constantly on the move. We are in fact, in very rudimentary terms (because I don't pretend to understand it all) floating on a mantle that carries us from one place on this globe called earth, and delivers us, over time, to another place. And guess what, we have no control. Zero. Its almost as if we're in an eternal game of continental bumper cars, over say... 4.5 billion years? And what's amazing about all of this. is that the underlying processes literally do mean that although our continents reside on different "plates", our worlds constantly collide with each other, in ways that are sometimes unexpected (remember the movie Crash). Earthquakes are but one example, but we are connected,.. not only in human terms, but in eternal, geologic ways. Connections that are inextricable, about which we speculate but cannot eradicate. Yes, we are joined at the hip or at the geologic trench, rift or plate, if you will. The late famous astronomer Carl Sagan has said that we are " star-stuff". That's actually not an abstraction, but it can be difficult to place into the context of the here and now. We could also say just as emphatically that we are "earth stuff". Connected undeniably and irrefutably... on this planet,.. here and now.

The Japan disaster reminds us of our vulnerability and fragility, but should also remind us that we rent this planet. For 2 to 4 million years (depending on your reference source), we have developed as a human species, created civilizations, empires, cites, etc. We've constructed, destructed, multiplied, gained possessions, recycled, gained more possessions and arrived at our present state. All of this, on a planet that we rent, but that lives, literally, beneath us, and that controls our daily existence (If you don't believe this, then checkout tomorrow's weather forecast). So if the owner decides to remind us that we are tenants, by rearranging the furniture, should we be shocked?

We are surprised because of the toll in human suffering. Because of the calamitous nature of the scope of destruction that has occurred, we are horrified. Indeed, human suffering is cause for concern and sadness about the plight of our neighbor. But are we also horrified because of the movement of the furniture that we think is ours? We've furnished the apartment perhaps, but maybe the owner doesn't like the arrangement. Perhaps, there's a reminder in this that thinking and priorities need to be re-examined, if not re-aligned.

Just food for thought, but for the 4.5 billion years this planet has existed, earthquakes and worse have occurred. Natural tragedies will occur for however long this planet exists. But we're horrified because while we're here, the furniture has been rearranged, and our daily routine has been altered so that now, we have to rebuild our lives. We have to establish a new and perhaps different "floor plan". But because human suffering has emerged, as it always does, maybe that floor plan will involve caring for our neighbor in ways that have lasting impact and are eternal. ... Maybe,... just like the earthquakes and tsunamis.

It only happened around the corner

2011-03-11T05:27:00.000-08:00

Think of a fire in your neighborhood,.. around the corner. Or a car accident,... Maybe there's an explosion at the factory around the corner, that shatters a few of the windows in your house. Or, maybe there's an earthquake off the shores of Japan, followed by ocean waves that begin to ripple onto your shores in Los Angeles, California.....5,500 miles away,... merely around the corner.

The circumference of our planet is 25,000 miles, large enough to maintain some distance between neighborhoods, small enough to feel the ripples of whatever happens everywhere.

Reminders that we are a global neighborhood come in all forms. This week alone, in a Pennsylvania Amish community, 7 children died in a house fire, leaving devastated parents, a diminished community and a saddened world. A few miles outside of Philadelphia, a teenager took the life of his twin brother and their parents, leaving a shaken and bewildered community and a diminished and saddened world. Affects us all. The ripple effects enter our worlds, wash onto our shores and diminishes and saddens all of us. Let's remember in prayer and hold dear in our hearts those who are "flushed" away by waters of Tsunami's or those who are taken from us in house fires or home murders. If you measure a light year as 6 trillion miles, with the star closest to our sun being 4.5 light years away, on this planet, whether 10 miles, 5,500 miles or 25,000 miles, they're all merely around the corner or maybe even next door. Let's keep our world in prayer.

Taking it to the Streets

2011-03-11T04:56:00.000-08:00

From the website Rethink Church, this post authored by Ben Rhodes, caught my attention. Its interesting and refreshing that this Church is in fact looking at how another perspective can be offered to those who might not otherwise enter a church. Our times are difficult and whatever your faith system is, we can probably agree that fear grips us at every turn. Taking hope to the streets as an antidote for fear, an avenue on which to live during our enormous feeling of uncertainty, is actually the method Jesus used to bring those of His time closer to God. ... He took it "to the streets". So what would the world look like if more of us looked beyond our Church walls. Read on:

With handmade signs that read “Got Ashes?” members of Urban Village United Methodist Church took to the streets of Chicago on March 9 to commemorate Ash Wednesday, the first day of Lent. They offered to mark a cross of ashes on the forehead of anyone who asked to receive it.

The Rev. Trey Hall, pastor of Urban Village, joined three- and four-person teams at six sites across Chicago. He says the gist of the teams’ invitation was simple: “Everybody’s welcome – Catholic, Protestant, gay, straight, everyone.”

Locations included rail stations, busy intersections and Daley Plaza. Banners at the sites read “Urban Village Church: Doing Church Differently.”

The 1-year-old church has members from a variety of faith backgrounds, including some who are new to the Christian faith. The church explains on its website that the cross of ashes is “a reminder that we are finite, that each of us has only a short stretch of time on this good earth, and that we should therefore live it well.”

In all, nearly 300 people received ashes – including two people who were waiting in their car for a stoplight to change.

Hall says that many of the people likely had at least a basic understanding of Ash Wednesday. Others were not as familiar, but were intrigued by what they saw.

“We answered people’s real questions: ‘What is Lent?’ ‘Why are you doing this?’ ‘What is this about?’” Hall said. “If we can reach people who wouldn’t be in church anyway (on Ash Wednesday), then it gives us a chance to talk.”

Hall finds an example in John Wesley, who founded the Methodist movement. Wesley is known for conducting much of his ministry outside of churches.

“Wesley was successful in connecting (people outside the church) to the larger, more mature Christian story.”

Even some longtime United Methodists were able to be a part of Urban Village’s Ash Wednesday observance. Chris Crook, a member of St. Andrew United Methodist Church in Plano, Texas, was visiting Chicago on Ash Wednesday.

“I was worried that I could not attend an Ash Wednesday service this year,” Crook said. He received his ashes on Michigan Avenue – and then he shared the details with his Facebook friends.

Hall and his church members are pleased to have offered individuals a connection to God that they might not have felt otherwise. He added, "Perhaps, by God’s grace, a tiny seed was planted."

The Senior Partner

2011-02-15T13:00:00.001-08:00

I saw this today and just couldn't resist....

Traveling Light

When Jesus sent his seventy-two disciples out to minister, he told them to travel light -- no walking stick, no travel bag. There was to be no suitcase for carrying a change of clothes or for stashing away a sandwich. And all of this at a time when there were no laundromats or fast food places! What symbolism. Jesus asked the disciples not to rely on themselves. Their task was a difficult one, but it was to be accomplished by God's power, not theirs. Could all of this have a personal meaning for us?

People are challenged whenever they offer love and hope to those who sometimes might seem unlovable and hopeless. Those who care for others have to travel light, for they have to rely primarily on God's power rather than their own. And the result of their efforts will finally have to be God's concern rather than theirs. In that sense, traveling light would mean a total trust in God as we offer our care to those who need it.

Traveling light doesn't come easily for me, Lord. I'm tempted to trust too much in my own methods and to be too attached to the outcomes of what I do. We work in partnership, Lord, but help me to see that you are the senior partner.

Its a slippery slope,.... Be careful out there

2011-02-09T07:58:00.000-08:00

Let's take a break from Kenya. Let's talk about Philadelphia.

I think this is a story about hope gone bad. A misguided, out-of-control, switched-track sort of hope, of which we are all capable. Its a slippery slope. But I've hesitated writing this because I have frequently held that horrific events speak for themselves and many times we can engage in rhetoric without resolution? However, important issues were raised in a column recently published in the Philadelphia Inquirer concerning the case of Dr. Kermit Gosnell, a local obstetrician who one worked against the mistreatment of people of color in the medical system. Outrage and disgust are two of the obvious terms that come to mind and so I'll dispense with them now so as to not trivialize the matter further. More descriptive words do not occur to me at this writing.

But there is power in language, nonetheless, and if through words, we can begin to consider creative resolutions or at the very least, how to avoid the path toward evil (the ultimate objective?), then let's see how we can begin the discussion,... meaningfully.

The story of Dr. Kermit Gosnell is one of profound sorrow. The alleged events that at least 8 infants were brutally murdered through savage abortion techniques, and that at least one mother was killed are indeed beyond human understanding; a tragedy for both victims and alleged perpetrators and far beyond sensible explanation. The specific issue of how the health care system and those responsible for safe guarding health health of the disenfranchised has been recognized and given voice over the years. Yet the larger injustice, of course, is that the conditions giving growth to this situation have persisted for decades and still the "victims" themselves of the non-functional systems remain voiceless. Unfortunately, unless political, economic and other societal staples are reconditioned, we''ll continue to be confronted by such health disparities and people will continue to die. Sadly, all said before without much change. But we know it doesn't have to be.

The story, for me, takes a personal detour here and in a different and profound way, begs a larger question: How did the life of a promising young physician turn sour? What happened?

In the early 1970's I was a student that the Philadelphia College of Pharmacy and Science (now the University of the Sciences), in Southwest Philadelphia. A gentleman by the name of Herman Wrice, founder of the Young Great Society (YGS), came to speak to my class about volunteering in the surrounding neighborhoods, Mantua, Powelton Village, etc, for educating those in the neighborhoods about the value of appropriate health care, working at clinics, etc. For those of you unfamiliar with the civil rights landscape of Philadelphia in the late 1960's and early 1970's, the Young Great Society was created to combat some of the very neighborhood-damaging ills that are present in today's social environment: drugs, gang and personal violence, poverty, poor education, ..you get the picture. Herman Wrice was its founder and one of the leading neighborhood activists of that era. Accompanying him was a young physician by the name of Kermit Gosnell. Now, when told about the upcoming visit by Mr. Wrice and Dr. Gosnell, I expected a white, idealistic physician who would talk about the desperate needs of the neighborhoods without much follow-up. In those days, young black physicians or black role models of any profession who would come before a pharmacy school composed of mostly caucasian students were hard to come by. We were mostly trying to find our own way, not for neglect of others, but simply because we were oriented in the mold that after you find your way, then go back to your neighborhood and make a difference. That was the tract I thought I wanted to pursue. So when Dr. Gosnell walked into the room ..tall, lanky, proud,..clad in bell-bottomed pants, an open collar "superfly" shirt and an afro,..a sway of arrogance and defiance?,... sure, ..but personally, I was impressed that this was someone who had indeed come back to his neighborhood to make a difference in improving the quality of health care for his neighbors. He in fact proceeded to talk passionately about how we can achieve balance in health care in underserved neighborhoods. He asked for volunteers in this effort and I and my best friend, both African American (2 of 6 in a class of 150), gladly did so, and were the only ones.

As it turns out, not much came of that effort, but still, he had credibility with me because he was "hanging out" with Herman Wrice, one of the premier community organizers of our time, and because he gave an impassioned talk that realistically depicted the health care situation in the neighborhoods at the time. Students of the era at many institutions were inspired by the few who tried to embed some semblance of hope and encouragement in us when we were caught between not knowing how we could contribute to the upward mobility of society, and being bombarded by television images of police forces hosing and killing students on college campuses, if we dared to try. We think of Martin Luther King, ... but there were others,.. Leon Sullivan, David Richardson, Herman Wrice. Many of us went on to obtain graduate degrees and embark on a successful careers, while trying to meaningfully contribute to helping achieve equity in our society. Indeed, much of what has been accomplished over the ensuing decades has been because of those who tried to lead us by example, activism and sacrifice, and who (sometimes unwittingly) left lasting impressions while doing so. Among them, Dr. Kermit Gosnell. He and others showed that someone could, in fact, show care and hope in dealing with very real society issues, at the same time that a successful professional career was being pursued.

So, Dr. Gosnell's story leads me to ask : What happened? Can this derailment of hope and encouragement occur for any us? It can indeed, and so the even larger issue is: how do we remain hopeful and continually remain a source of inspiration for our young people in all professions? Its still rare to find professionals who are willing to share time,... we're all very busy and are distracted by other "more important" needs... being present takes time, ...showing up, takes time from other things. Leading someone through the discouragements of life takes time.

Perhaps we can learn from Dr. Gosnell's story that we are all vulnerable, despite an initial life attitude that seems admirable, but can, overtime, erode and become misguided. The full story isn't yet known, but we do know, or at least suspect, that Dr. Gosnell once held the hope that he could help his neighbors improve the quality of their lives. It is sad that someone whose gifts that are so desperately needed, did not continue to share those gifts for the betterment of the community he professed to love.

In this, we all need to be careful.... It is indeed,...a "slippery slope".

The good and and bad news,,.. or skylines

2011-01-29T00:06:00.000-08:00

Los Angeles,... Chicago,.... perhaps New York. Could be anyone of these cities. But this, ladies and gentlemen is beautiful, downtown Nairobi Kenya. Makes you wonder doesn't it. How such a modern skyline in the capitol city of Kenya can exist adjacent to some of the most desperate poverty we know. And the progress of this city doesn't stop with its high rise office buildings and hotels.. Everyone is excited about the construction of modern "super highways". Literally, the boasting and expectation of relieving some of the worst traffic nightmares in the world is heard from many corners,... from drivers who are truly skilled at maneuvering tight spaces without traffic accidents, to pedestrians who narrowly escape death by crossing through these tight spaces, especially on the round-abouts. It has to be seen to be believed. But this is modern Nairobi. Its still building. The new highways are actively under construction with a target completion date of sometime in 2012. The excitement here is palpable. The scenes are far from the poverty ladened pictures that routinely are seen in media outlet.

Much has changed since our first visit, some 17 years ago. In those days, cell phones were far in the future, in fact, communication more often took place through unstable and unreliable phone connections and then more often than not infrequently. Now through fiber optic lines its inexpensive and reliable. The skyline certainly wasn't what it is today. The attitude of Kenya's citizens was largely one of despair. Changes over the years have brought vitality to this metropolis and with continuous renewal of hope, fostered in large part, I'm told, by it current leadership. There are mis-steps by the government to be sure, at the parliamentary level mostly. But the excitement of Nairobi is truly a good sign of a properous present and future. Congratulations are certainly in order.

That's the good news.

Meanwhile, back at the ranch, as they used to say (showing my age maybe?:-), even within this capitol city of Nairobi, within Kibera or Mathare Valley for example, each with at least 1 million desperate inhabitants, starvation, lack of cleanwater, illness and despair remain the order of the day. That's the bad news. But it can be even worse in the "upcountry" or places where the concept of a downtown Nairobi or Los Angeles, or New York is as unreal as traveling to another galaxy. Dreams of Nairobi are hard to find when their dreaming instead of feeding their children or having access to basic health care or clean water without traveling for one day to the nearest "borehole". This is a different skyline. That's,.... the very bad,... and sad news.

There's an obvious disconnect. Recognized by all, many stating grand plans to eliminate it, but the task to bridge the gap is huge.

Consider health care. There is a 6.3% prevalence of HIV/AIDS in Kenya, a nation of 40 million citizens. Of those with known HIV, the highest estimate of those receiving treatment is approximately 400,000. The most commonly heard figure is 200,000. So approximately 20% of those needing treatment are actually receiving treatment, at best. The enormity of this problem is probably felt strongest in the rural areas,.. not in city center Nairobi. And we don't even know what's happening at the cross borders at the juncture with neighboring countries, where mobility between countries combined with an enormous sex trade, provides the ingredients for explosive HIV prevalence. What to do? How can the gap be filled?,.. if only in this one example.

We all have the power to heal... if not physically, then emotionally, spiritually and socially. The gap can be filled through simply caring about and fixing the systems that produce the gaps in the first place. But Jesus made it even simpler than that. He healed through touching people. People were healed through touching him... and sometimes, by touching only his clothing (...If I can only touch the hem of His garment,.. remember that one?). Healing happens when we enter and touch each others' lives, or maybe even by coming a little closer than we are accustomed. Maybe someone needs only to touch our clothing to be healed. Gaps can be bridged, ... health can be restored and healing can take place.

The disconnect we feel is real. Fixing or lobbying for fixing systems that explode this disconnect either in Nairobi or in Philadelphia can heal and fill the gap, ..... bridge the disconnect,.... help us to touch people's lives. Maybe this will allow all of us to scrape the sky,... sort of like the skyline of beautiful downtown Nairobi.....Maybe.

Simon: "I want to serve"

2011-01-25T00:33:00.000-08:00

Simon is a Pharmaceutical Technologist in Kilifi Kenya. Kilifi is in the Coast Province of Kenya, just on the Indian Ocean. Overall, it’s an apparently quiet place,.. nothing like the capitol city of Nairobi.. The traffic jams are non-existent, but people go about their daily lives just the same, albeit in a less frenzied pace. Simon is the chief pharmacist at the Kilifi District Hospital,.. the hospital responsible for the health matters of almost 5000 square miles (about 12,500 sq Km) of kilifi district.. So his job is to facilitate delivery of medications to hospital inpatients as well as those in close proximity to the hospital.

Its not an easy job. Dealing with the medication needs of the hospital is one thing. Dealing with the needs of the surrounding community is yet another. You see, the way it works is that, although the hospital takes care of some of the community medication needs, the majority of these needs are managed by dispensaries and health centers “closer” to those. Closer, is in fact, a relative term. There’s a phrase in Kenya used often when talking about distances, especially on the coast. That phrase is: "just here". When asked “are we there yet”,.. the usual response is” its just here”, which could me we have another 10 Km to go,.. but its “just here” in Kenyan terms. So the community health centers of Matsongoni, Ganze and Msumarini, are “just here”.

On this particular day, we’re driving between health centers and dispensaries, on not so smooth “off” roads to places where the villages and homesteads are disbursed some distances from each other. We’re driving and the time seems endless. Can’t imagine how it feels when you’re walking. And that’s what they do…. Walk. To “just here”.

Some of the places have only nurses and maybe a clinical officer, but certainly no physician and no pharmacist. Simon explains that there is an acute shortage of pharmacists and physicians in the medical system of Kenya, especially in the rural areas. When asked why, he further explains that the pay is low and the circumstances are cruel and demanding, the hours, grueling. Many health professional go the private sector, where pay is much more than when working for the governmental health system, as Simon does. So I asked Simon,… Why do you do it? His response: I want to serve.

Simon is a rarity, even here. If you had to go to work every day to provide a service to those who might night be able to pay, whom you might contract a respiratory disease from, where you might hear babies crying in anguish all day…. Would you do it? Many here won’t,.. But many will. And the truth is that most of us serve, in one way or another. But because Simon serves here, one more child will live. Because he is planted here, a mother will receive medication so that she can look for work, or, work on her farm, or, sell goods in the market place…..because Simon serves,… and inspires others to serve. In this, there is hope.

But that can happen anywhere, it can certainly happen in the U.S. where the needs are as great as they are in Kenya or anywhere, ...the difference is that we have systems that, arguably, could work and should work on our behalf. But similar to Kenya though or anywhere else for that matter, if systems don’t work on behalf of the poor, the rest of us are called to serve,.. like Simon, and with intention,.. not the intention of being recognized for service, but with the intention of lifting someone up. With the intention of being an instrument of justice, not charity. With the intention of “leveling the playing field”, which may not happen immediately, but over time, it happens. Simon knows this, and so he serves.

So, in our lives and travels to “just here”. What intentional service will we render today? We're all thinking about this, but going beyond thinking and into action is yet another matter. As we go beyond action in our own lives, one more child will live.

So Simon "toils" on, ...with joy, sometimes frustration, yes,.. but always with intention. Can we join him?

They're coming from everywhere

2011-01-22T19:30:00.000-08:00

They came from everywhere,… as far as 20 Km from their village or homestead to this place called Ganze Health Center. It was small, had services like laboratory evaluations pharmacy distribution, HIV/AIDS counseling, but it was literally “in the middle of nowhere”. But it rendered service. Service to many who had no alternative, because they were sick or dying, because they knew no remedy,.. not even the herbal medications extracted from the field worked any more. The pain just wouldn’t go away. Or, maybe the skin infection from which their small child suffered was more than the young Mother could bear to see.

They came from everywhere, to this place with no Doctor, no Pharmacist and sometime no medicines, at least not the ones they needed. Frequently, they were told that the medicine wasn’t there. That they needed to go to the “local” chemist. But there they knew that the cost would be high, the distance sometimes far. Yet the clinical officers and nurses offered the care they could, providing the medicines they had, despite frequent “stock-outs” rendered by delivery shortages from government distributors.

Imagine your medical center that you traveled 20 Km to reach. Imagine not having an automobile or even public transit to reach it. Worse yet, imagine not having the money to travel by public transport, if it was available. Imagine no water, little food and insufficient strength to travel the long journeys, by foot, to receive some semblance of health care. Yet they come, because there is no alternative, because death stands close by, watching to intervene, if they don't come.

Global healthcare is in crisis. Obvious?... perhaps.. but we sometimes do not recognize and why people are so sick, nor why they remain so sick. Environmental reasons are surely present. There are places experiencing drought. Climate warming has taken a heavy toll. In places where mosquitoes and other insects prevail, malaria, denque fever and river blindness are similar in their prevalence as the common cold is in our world. The planet is large, and so there are still places yet unreached by roads and other symbols of infrastructure. Cities, towns and villages remain separated by huge distances. Although this separation has been mitigated somewhat by communication amenities such as cell phones and the internet, the east does indeed remain far from the West.

The larger tragedy is perhaps we haven’t considered what we can do about all of this. But its hard to even think about how we can take care of our neighbor, especially when the neighbor is on the other side of the globe. But what about our neighbor around the corner or next door. Its hard work. Given all that we must contend with to take care of our own lives, and now we’re asked to care of someone else’s life. I don’t think so. Its easier to just look away. Maybe when I look back, it won’t be there, or maybe it’ll take care of itself. Isn’t God watching out for this? Doesn’t He care?

Suffering is everywhere. They do come from everywhere,.. next door, around the corner, around the world, …and it doesn’t go away, if we pretend its not there, or if we simply look away or close our eyes.

A thought. Maybe God is watching, but watching to see what we’re going to do about the suffering, the pain our neighbor is experiencing. Maybe God is watching to see if we’re going to build a clinic 10 Km or 5Km closer to the village so that our neighbor doesn’t have to walk 20Km. Maybe God is watching to see if we’ll drill a well to a level where we can access water in areas where clean water, or just water is needed, or creatively devise other methods of water access on a planet where, despite drought, 75% of the surface is water. Maybe through creative research we can develop vaccines that will combat malaria or HIV. Or maybe we can enact a truly comprehensive health care law that will insure everyone. Maybe God is watching out,.. to see what how His creation will take care of each other.

Cain’s response to God,” Am I my brother’s Keeper?” has not been diluted across the ages. We’re still asking “Am I my brother’s keeper. And we’re still trying to avoid the obvious answer.

Not 25 anymore

2011-01-18T13:20:00.000-08:00

Well, I'm not 25 anymore,.. or even 30 or 40. I've crossed over.. Crossed over to what you say? To the senior class,.... elderly if you will, those who are close to collecting medicare,.. or maybe we should already be collecting it.

I came by this startling revelation, when there I was, trekking through Kibera with my student team who are 25. Of course, I went through the paces, the hills, the rough terrain, the valleys, and the the hills again, as if I do this every day. The pretense was, I must admit, impressive, but so was the shortness of breath. Of course, I didn't dare let them see it,.. carrying on a conversation while at the same time drawing huge gulps of air. My alternating timing was perfect. No one knew, I think, that with each syllable was an equal and silent gasp. But in the end, I made it. Not 25 anymore.

So if you're inclined to hangout with those who are 1/2 your age (or maybe more?), fess-up, admit the disparity, or,.. if you don't, and you happen to keep up, the alternating breaths will do wonders for your sense of rhythm. But it may be easier to take up the bass guitar.

From peace at St. Mary's Guest House to using outrage as an expression of love

2011-01-16T20:55:00.000-08:00

We’re staying at St. Mary’s Missions Hospital Guest house. Both hospital and guest house are within a gated compound on the outskirts of Nairobi (Langata). It’s quite secure with a bustling shopping area of small establishments just beyond the gate. By the way, the U.S. has no monopoly on three hair salons in one block. The local CVS and Rite could best be described as a small chemist shop in one block and Duka la Dawa (drug store) in another. Its not clear who owns these drug emporiums, by the way. Regulations are that only pharmacists or pharmaceutical technologists can operate such businesses,.. but when asked specifically about this, there’s lots of throat clearing and uncertain answers,.. so who knows. Let’s just say, I might be inclined to purchase my Advil somewhere else J. There are “real” pharmacies in Nairobi. Kibera, probably the largest slum on the continent, is within walking distance, and getting there, literally, can be done within 5 minutes (but the hills are steep, and if you’re over 30, you’re body doesn’t lie). The people are as congenial as you would want them to be with greetings of Jambo (hello) or Habari yako (How are you?) exchanged commonly, and it is quite uncommon to find anyone, particularly at the shops, who doesn’t end a conversation with asante (thank you) or karibu (you’re welcome). These are gentle surroundings.

Its educational as well. This past week, the guest house was host to a medical missions team, two physicians and 6 medical students, from Korea. This group was on its way to Tenwik Hospital, another missions hospital in Kenya. Frequently, travelers pass through here for volunteer work, study, or other activity that requires a temporary stay in Kenya. Next week another group is visiting from Korea. Last year, I shared this space with a group from Australia who operates a school in Kibera, and a missions pilot who regularly brings supplies from Russia. The stories the staff could recount, as well as those of us who are blessed with their hospitality, are numerous. There are those who return to St. Mary’s Guest House repeatedly as well as those who live here year round. Its easy to see why.

I have learned and am still learning that there is no greater gift to another human being than giving compassion. Moses and Leah, the staff at St. Mary’s, are hospitable, gracious and kind, providing a quiet, warm and required respite for those who extend compassion to others or who are in need of compassion themselves.

Children are abundant on the grounds of St. Mary’s. This is because the compound is also home to an educational center which contains a school for orphans. Even under these circumstances, children have the most delightful way of affecting our lives. Saturday morning, we were awakened by singing. Yes, literally awakened by singing, unintentional, yet deliberate. You see, the Educational Center is located within 25 feet of the guest house and the children were celebrating mass at 6:30 in the morning. There is no more beautiful sound than children singing in Kiswahili. And to be awakened by that sound on a Saturday morning, in Nairobi Kenya, is a statement from God, that at that moment, in that space, all is right with the world and that there is indeed hope. I remain convinced, that this is one of the many ways God extends compassion to us.

But compassion doesn’t stop there. We are called to multiply that compassion to, and in, others …, and if we are to link that compassion with hope, we must multiply compassion, especially to our children. But the multitude of children at St. Mary’s is only a microcosm of the children in Kenya, or in Africa in general. We can also see children in St. Mary’s Hospital. We see them at Carolina Clinic in Kibera,... and then, of course, there's Good Samaritan orphanage in Mathare Valley, another large slum in Nairobi. These children are heard too, and although surprisingly, these children sing, there are also tears.

A recent quote I’ve read states:

"Let us be the ones who say we do not accept that a child dies every three seconds simply because he does not have the drugs you and I have. Let us be the ones to say we are not satisfied that your place of birth determines your right to life. Let us be outraged, let us be loud, let us be bold." —Brad Pitt.

I could be wrong, but I think Jesus would have been outraged. His quote was: “I have loved you with an everlasting love.” I think he meant that, and I think that he meant for us to love each other with an everlasting love. Never to allow our neighbors to suffer for want of a clean glass of water,.. or even a hug. In overturning the tables in the Temple, Jesus showed outrage and anger at the prevailing culture. In our time, given our circumstances,..perhaps our call, simply, is to overturn our tables.

Let's talk about traffic jams,.. or, finding the real story

2011-01-12T14:48:00.000-08:00

Traffic jams, .... not moving,....summer heat, ..... in meetings,...... out of meetings,...... what are they saying?... I don't believe it, ... but maybe its true,...... let's think about this some more. Whew,.. what a blur of information, and in just two days in Kenya, .. looking for answers,.. finding none,.......only more questions to matters pertaining to their health care crisis. Is it pharmaceutical manufacturing?..medication distribution?...insurance access?....governmental funding?..., all or none of the above? This is like the automobile traffic jam we're in,..... not moving (especially the round-abouts,... are we going in circles?... again?) The initial confusion is astounding. But isn't this what research is about?

Two days in Kenya,... traveling with M.I.T. students who are doing a marvelous job at digging beneath the surface to look for answers about addressing health access in this country of 40 million. The scope of the mission has broadened immensely, and, unexpectedly from the initial premise of how to improve the quality of pharmaceutical manufacturing in Kenya.

But issues have been revealed that are begging for closer examination. Such examination isn't easy: Discussions are being held with experts who claim to know the system. Endless meetings and opinions are expressed on how this confusing health care system actually works and how it can be improved (sound familiar?). Those in the know will say that twenty-five percent of Kenyans have health insurance (and we thought we were in trouble). But who are these people? Others may state that the HIV prevalence in Nairobi is in the vicinity of 4%, but in other areas, as high as 18%. In a country where 75% of the population lives rurally, with no transportation, no access roads, little infra-structure, except in urban areas, it seems that it may not be easy to determine who is insured and who is not, who has specific diseases and who doesn't, when most of the country can't be reached (at least easily). So how do we really know? What are the "real" figures? The opinions expressed are from people who claim to know how things work in Kenya. But do they really? Are they really familiar with the faceless uninsured, the unreached, the uncounted 30 million who live without voices? Can't help but wonder who is the keeper of the truth, or, is there only mass denial that people are grossly under served and that we, the "keepers of the truth", have failed to respond to the needs of our neighbors, to facilitate equity and the entry of justice in health care. We all bear responsibility and accountability for these disparities. But, the question looms: are we even talking to right "experts"?

So the students have begun using an alternative and novel approach,..asking questions on these issues of other experts: residents in Nairobi,..patients at pharmacies, health care workers, people in the system rather than above and overseeing the system. People who also have opinions on how this system can better serve,... them. People who are frustrated with being witness to a system that can work but doesn't. People who have grown weary of hearing opinions from other experts who only claim to know the system... those who operate under the pretense of managing health care systems on their neighbor's behalf. So the questions being asked of these "experts" are only in the preliminary stages of inquiry. Yes, we're in the mystery of not knowing where the questions will lead. But there is little mystery in the fact that interesting yet troubling stories are beginning to emerge,.... a disconnect between what is supposed to happen and what actually happens.. in this metropolitan area of Nairobi. So, I suppose that we can add to the traffic jams, mismanaged health care systems and low allocation of funds that continue to frustrate residents, and perplex outsiders asking questions of "experts", ..those that are in the system and those that are responsible and accountable for it. One supposes that this may be another traffic jam,..of sorts. We're speculating further that somewhere in the questions posed to these disparate groups of experts, lie honest answers. But,.. if we're finding these types of challenges in the metropolis of Nairobi, one can only imagine what stories will be told when questions are asked in Mtwapa, and Majengo, where we're headed next week. The story will evolve further and the "plot will thicken". So stay tuned. These are stories that we should all hear. Stories that may provide light so that Kenyans will find the way out of their health care traffic jam.

Back to Kenya

2011-01-08T04:09:00.000-08:00

Well, here we go again,... back to Kenya, back to Nairobi, maybe Mombasa, back on the road to talk to men and women who are so desperately in need of hope....in need of a hug, hand-holding, a smile,.. you get the picture. And those are just the needs for human contact. Taking that out of the equation, what about the need for clean water, for food, for medicial care, for justice? Not that we can provide all of these aspects of daily living,.. but we can try. We can try, as best we can, to bring hope to hold someone's hand, to facilitate access to clean water, to food and all the rest. But in the end the challenges are enormous. But Jesus wanted us to start somewhere, with the hope that one candle lit would allow others to envision and light their candles,... as people see, not only what is, but what could be, that lives would be changed.

The young man with whom I'm traveling from the Philadelphia area, wants to experience the vision,.. but more than that, he wants to feel the vision. How can people in need be given the chance for life that most of us in the western world experience? What' s necessary for justice to be given to those who are left wanting by colonial systems, long gone, but present, still? This young man seems to want to find out if we can make a difference simply by going, simply by showing up, because in that, and in that alone, there is inspiration for others to do the same. Inspiration,... especially if you are a young man with the fortitude to travel 8,000 miles to ask "How can I help?", of those who are in desperate need. This young man is becoming a man of vision.

Nehemiah would have been proud. Nehemiah knew that Jerusalem had been destroyed, that there were challenges in the re-building of Israel's capitol. In the distress this caused him, he knew something must be done. In his distress, he envisioned a new Jerusalem. In his distress over the destruction of Jerusalem, his home region, Nehemiah knew he had to go to see how he could help,.. how he could allow his vision to become reality,.. in His home region. Nehemiah would have been proud of the young men and women who ask "How can I help?", and then actually show up. What an extraordinary thing.

But when people suffer, when they need the very basics,,, in Africa, in South America, in the Ukraine, in Haiti,...(isn't there need everywhere?)...shouldn't all of us ask "How can I help?". Isn't this planet our home region. When people suffer, when we travel 8,000 miles to show up, aren't we traveling around the corner in our own neighborhoods? When Nehemiah shows up, when others shows up, when you, or I just show up, the vision of how Jerusalem can be rebuilt inches just a little further toward reality.

So, we're leaving for Nairobi Kenya tomorrow. We're meeting four M.I.T. students, my colleagues Steve Praissman and Titus Kahiga, and staying at St. Mary's Guest House on the grounds of St. Mary's Missions Hospital. We're leaving with the hope,....the prayer,... that we'll come just a little closer to rebuilding this part of Jerusalem and inspiring others to come to the feast,.. to join the construction effort.

From time-to-time, we'll post some observations on this blog. I believe that as you read, as we explore, how we can help,.. that we're co-travelers. Thanks for being part of this journey.

Imagine the Pentecost..... then... and now

2010-05-26T03:12:00.000-07:00

The passage starts with a picture of the church gathering for prayer – not at home but in a special meeting place. The room was packed with all the believers, about 120 of them. It was a regular focus and priority of the church.

And then while in the midst of one of these prayer meetings, when all were present, the Holy Spirit descended in a new way and dramatic way. In a show of controlled power THE SPIRIT came in the form of a violent wind that filled but did not destroy the house. And then THE SPIRIT manifested Its presence via fire from heaven that did not consume them but miraculously separated and rested on each individual.

The Holy Spirit came as a violent wind and fire to anoint the church with symbols of power and purity in response to their obedience and commitment to God.

The Holy Spirit then proceeded to enable them to miraculously speak in different languages. Around 120 people praised God in all the known languages of the Roman Empire, and yet without any confusion in the message. It was an incredible sign that God was ushering a new era where everyone irrespective of race or language could be united as a people of God through Christ.

But what of the present day? What is the Holy Spirit saying to us today? Are we still united with God through Jesus Christ? Are we still speaking in different languages, with different thoughts, yet find commonality through God without confusion? Or are we waiting for another Pentecost?

Imagine the scene, as the 20th chapter of John describes, the disciples cowering in a locked room—afraid. They are afraid of death. They are afraid of violence. They are afraid of responsibility. In a word, they are afraid of life. Without Jesus leading them, comforting them, healing them—without Jesus living life for them—they simply cannot imagine a future of meaning and purpose.

Picture then, Jesus suddenly appearing to them, ignoring locked doors and locked hearts. He simply appears—breathing into them, onto them, among them. Re-creation—a new beginning—the Word becoming flesh, this time in the brand new birth of an infant community. It is a community that will call itself church—a community that now has in them, on them, and among them the resurrected power of Jesus. And so, they—we—become the resurrected body of Christ in the world. ....Amazing!

When God sings through the birds, or breathes through the wind, do we see Him appearing to us? Or do we, like the cowering disciples, fear life locked in an anxious faith, afraid of life’s mysteries without the visible Jesus? Do we heed God’s calling in our lives, or are we waiting for someone else to do and be who God is calling us to do and be.

Do we see God in quiet, unexpected, faithful places Jesus, not to do ministry for us, but to breathe ministry through us—a re-creation of passion and purpose for our living, Churches and individuals who are doing marvelous and miraculous works in His name and through the inspiration of the Holy Spirit,… another breathing of the Pentecost.

Another Pentecost? … Whenever we choose to lock ourselves up in our human frailties, our utterly dependable God will not leave us alone. God comes to stand in our midst and breathe upon us—passing on resurrection possibility to us and sending resurrection power through us to resurrect the world. This is the good news of the gospel. This is the Pentecost promise.

But would we recognize Pentecost if it happened today? Distracted by disasters and mayhem, multimedia events, real and fabricated, it is difficult to discern the work of the Spirit in our midst. So what of little Pentecosts— the scores of people who have gone to Louisiana or to the wreckage of the tsunami, or to Darfur, to Guatemala, to lower Manhattan in the World Trade Center catastrophe.

When people gather with no previous notice to pray for trapped miners and for children killed without warning, and those who write checks to stop easy purchase of guns and to fill food pantries, to correct birth defects, and to look with awe at those whose children were killed who forgave their killers, and those who vote as if their life and faith demand it.

When is all that a result of sons and daughters prophesying, young men and women seeing visions, and old ones dreaming dreams? Or,.. God’s Spirit pouring out? Another Pentecost? Pentecost happens in our midst all the time. Jesus appears to us all the time. Do we see Him?

We are God carriers.... a God of Surprise

2010-05-07T17:40:00.000-07:00

One of the great servants of our time, Desmond Tutu, speaks of his injunction to his parishioners in South Africa several years ago during apartheid, that they are created in the image of God, that they are God's helpers, that they are God carriers. Wow!!...This Speaking of Faith broadcast on a God of Surpises is extraordinary. He speaks of a God of surprises. If you haven't heard this, you should give a listen,.. only about 52 minutes,.. go on,.. you can spare it,...won't mention that God has spared an eternity for you,... You'll thank me later :>). Happy listening.

Wanting to change the world

2010-05-02T01:32:00.000-07:00

Energy, willingness, enthusiasm, vision, courage of your convictions. If these were clues in the game show Jeopardy, the answer would be, " What does it take to get on a plane and travel 8,000 miles, to practice your profession, in a place completely foreign to you?" Or you might ask, "How can we take the first step in trying to bring hope along with appropriate health care to those sometimes lacking both. Better yet, you might wonder, "If we think we can change the world, how do we begin to explore the potential for doing so?" Tam Nguyen and Saomony Cheam have asked themselves these questions. In looking for the answers, they've exercised their energy, they are certainly willing, more than enthusiastic, have vision that will propell them far in providing healthcare to their communities, and their motivation, their fortitude, their comittment, and most importantly, their conviction for exanding their world to the global community, runs deep. They are to be commended and congratulated for beginning their professional lives in a way that firmly establishes them as global citizens. But by definition, their chosen profession and their desire to reach the world will require continued vision and growth. This is a bold and uncommon venture. Drs. Cheam and Nguyen are more than able to meet the challenge. I am humbled and honored to have been their preceptor as they begin this journey.

I travel frequently to Kenya and over the years have developed a passion for using my profession as a tool for delivering health care to underserved global communities. Approximately a year ago, two students were referred to me by one of my former professors to explore the possibility of traveling to Kenya to learn more about healthcare in developing countries. Thus began a year of discussion and preparation to travel to St. Mary's Missions Hospital in Nairobi, Kenya for 5 weeks of intense learning.

Warmly embraced by the staff in general, my colleague and close friend Dr. Michael Johnson (a U.S. trained surgeon who has been practicing in Kenya for over 20 years), facilitated this venture from the Kenya side, while I prepared the synopsis/curriculum from the U.S. side. James Kimani, chief pharmacist at St. Mary's, provided guidance and facilitated exposure to the pharmacy and inpatient care areas as well as the TB/HIV and hypertension/diabetic outpatient clinics. Establishing relationships with the medical staff was key in this learning experience, especially since at St. Mary's, clinical pharmacy hasn't yet become the norm. Yet acceptance on the wards readily occurred and Drs. Cheam and Nguyen's presence among the medical teams making morning rounds was highly encouraged, if not expected. Once familiarity was established, which was probably after the first few days, recommendations and perspectives on therapy were frequently requested. In this, the seeds of a deepening relationship between the profession of pharmacy and these medical professionals, were planted. Previously, there was little knowledge of the important contributions pharmacists could make to increasing the efficiencies of healthcare at St. Mary's. The economics of healthcare are relevant here too, and so the chief pharmacist and his staff spend little time on the patient wards. Therefore, Drs. Cheam and Nyguyen are setting a precedent and establishing a framework for advancing the cause and recognition of pharmacy practice at St. Mary's hospital. Again, vision and courage take center stage, in this, an area that has never been considered at this Missions hospital,..but, an area that has now been introduced. Remember the question about... "If we think we can change the world...?" The world at St. Mary's has already been changed.

The nursing staff at St. Mary's has been introduced to a different way of relating to pharmacists. A paradigm shift has been initiated in which nurses have begun to consider and question the acute and chronic implications of therapies they administer at the request of physicians. Culturally, this is a difficult matter to address, but this, like other difficult issues raised, will be handled with compassionate team work and a view toward increasing efficiencies for the ultimate benefit of the patient. The presence of Drs. Nguyen and Cheam on the medical team along with their CME lectures (more on this in upcoming posts) have prompted much discussion on enhanced healthcare efficiencies and the contribution of pharmacists towards realizing these efficiencies.

The learnings that Drs. Nguyen and Cheam have gained will benefit their patients regardless of their ultimate practice setting. In the immediate future, Dr. Cheam is headed for South Dakota to work for the U.S. Public Health Service as Lt. Cheam. Dr. Nguyen will be entering a residency program in Loma Linda, CA. In both instances their future colleagues will be blessed to serve at their sides.

So applause to Drs. Cheam and Nguyen, their parents and overall community for sending them forth with a vision and conviction for wanting to make a difference. A difference that has already begun.

Will the real healthcare crisis please stand up?

2010-04-29T01:14:00.000-07:00

I can't decide which case is more troubling or unique,....is it the scrotal hematoma, ...or the roundworm impaction? Perhaps the adenoid hypertrophy or the circumcision that also resulted in injury to the ureter (which most certainly would be cause for a malpractice suit in the U.S.). The 16 year girl with Downs syndrome being treated for tuberculosis was interesting, but other than her Downs syndrome, not unique,... there's a lot of TB here. But I think the cases that most captured my attention were the Mother and two sons who had been sexually abused and consequent to "prophylactic" antibiotic treatment, developed gluteal necrosis, which is almost never seen in the U.S. Caused by injection techniques totally devoid of sterile measures, these infections were difficult for me to comprehend, but not for the rounding physician who I accompanied on this, my last day in Kenya at St. Mary's Missions Hospital. Dr. Johnson was well familiar with the unjustified horrors of the routine sexual abuse that occurs here. He understood that many face life difficulties here that have no basis of comparison in the U.S. He understood that for those without financial resources who face traumatic circumstances as a way of life, when medical services are needed, they can be found at St. Mary, provided by overworked, understaffed, yet caring physicians, nurses, pharmacists and others. St. Mary's will treat outpatients for 100Kes (Kenya shillings) (approximately $1.25) or inpatients for 350kes/day/bed ($5.00). Quite a bargain for health care, yet you will be seen, evaluated and treated for these prices. Its not Jefferson University or Einstein Medical Center, .... there may not be the latest medical technology or lab evaluations, but St. Mary's can be the difference between whether you live or die. Here, that's the very basic difference that counts. The very bottom line.

We've been in Kenya 42 days. During that time , we've established a solid and enduring relationship with the medical and pharmacy staffs of St. Mary's Missions Hospital, met with staff and faculty of the University of Nairobi, where I've lectured twice, and soon to be Drs. Cheam and Nguyen have collaborated with the U.O.N. pharmacy students, conducted five medical camps, toured Glaxo SmithKline Pharmaceuticals, M.E.D.S (Mission for Essential Supplies and Drugs),and met with individuals from KEMRI-Wellcome Trust to establish a method of database development for the hospital. So its been a busy time, and, an enjoyable time. Yet, I hadn't spent significant time in the medical clinics or the medical care areas, so as it turned out, when we asked who was doing rounds today and the response was 'no one', we did what any self-respecting physician and pharmacist would do, we started rounds. You see, St. Mary's is the sort of place where sometimes you work where you're needed. If you happen to be a physician and pharmacist team and no one has made rounds that day (for whatever reason), well,... you get the picture.

The pace is dizzying and exhausting, from the pedicatrics ward, to Women's Surgical and finally on to the Mens surgical,..with an array of disorders, discomforts, patients who have late-stage cancers, victims of road traffic accidents, those in need in skin grafts, and yes, those with necrotic tissue disorders consequent to inappropriate and incorrect use of antibiotics. We treat, order lab tests, correct orders, cancel some antibiotic use, discharge some patients, and overall, make sure that patients are receiving the appropriate care. Completing this, we move on to the outpatient clinic, where the pace is just as frenetic if not more so. St. Mary's sees more than 277,oo0 outpatients yearly, by the most recent estimation. Are there other hospitals in Nairobi? Yes, but none that serve the poor with the compassion and dedication seen at St. Mary's, and so, patients flock here. You can imagine that maintaining this pace on a daily basis, yields fatique, disconnection and often disillusionment. But those who keep this pace realize that the patient's need for care outweighs their need for rest (at least at the time). Its energizing but concerning to think about the over half-million people (patients plus those accompanying them) who come through these doors in need of physical and emotional healing. The goodnews is that, here, it can be found. The bad news is that the staff is overworked and 10 more St. Marys could maybe begin to quench the overwhelming medical needs of Kenyans. We finish for the day at St. Mary's,.. haven't eaten,.. we're drained emotionally, but excited about the child we were able to discharge because his adenoids were no longer swollen, or the women whose antibiotic burden was lessened because of the teachings from Drs. Cheam and Nguyen on pharmacokinetics, but saddened because of the 100 year old man who will die from prostate cancer because at this stage there's little to be done (his PSA was greater than 100).

But this happens everyday at St. Mary's,... a lot of patients are seen, yet only a small fraction of those who could be seen, ....if they could get here, ....if they had the $1.25 or $5.00/day for in patient treatment. The if's, like the why's, could fill this page...

We talk about the health care "crisis" in the U.S. But it begs the question,...even in the most desperate situations, will patients be denied care? Is there a way to treat all patients? Will medications be made available all, even to those who cannot afford them or are without health insurance? The truth is that even without the recent healthcare legislation, we all have access to healthcare. The question has been whether or not we're willing to create equality in order to erase the artificial boundaries to access. Are we, as a society, willing to do the work, up front, that will allow all of our neighbors the freedom to pursue our common human right for access to the state- of-the-art care. Too often, those without the time, without the resources, or,.. without the energy are forced to create their own access through avenues that are the birthrite of us all, but remain hidden in a thicket of bureaucracy and frustration. Too often, these potential patients lack access, not because the care is unavailable, but because of the inherent fatique, disconnection and disillusionment created by our system. So, maybe this is the biggest and most profound WHY. Perhaps one could understand, although not justify, inaccess to care, and resultant fatique, disconnection and disillusionment at an overworked Missions Hospital in a developing country, ..corrupt governments and all of that,... but then, maybe all of us are corrupt in our denial of the basic human right of healing for all. ..Hmm?!

Our collective blessings are many. Our collective challenge and our call is to insure equal access to all of those blessings. Perhaps its instructive to remember the universal implications of Martin Luther King's statements about the illusion of democracy, and that none are truly free until all have access to, and enjoy the freedoms.

Where has the time gone?. a few days to go

2010-04-24T20:46:00.000-07:00

These weeks have flown by,... can't believe our 6 weeks is almost gone,...but time does fly when you're having fun,.... and this,.. has been fun. In the past two weeks alone we've traveled the breadth of Kenya. From Nairobi to Kisumu on the shores of Lake Victoria, back to Nairobi, on to Mombasa, and back to Nairobi again. All along, studying this vast and beautiful country, its healthcare system, its customs, its people, its poverty, its wealth. And, as if we hadn't traveled enough, we then left for a 2 day holiday in Masai Mara, ... safari, anyone? The five weeks of this clinical service learning experience has officially ended. Its been a blast.

The two clinic days we had this past week, were in Laikipia district in places known only to those who live there,.. Sipili and Donyloip. Anyone who finds these on a map has my admiration, if not my suspicion that they just fabricated these names. But they do exist,. ask anyone, again, anyone who lives there, that is. But Sipili and Doyloip are real. The people are extremely hospitable and genuine, desiring a quality of life similar to that which is desired by all places on this globe. Sipili and Donyloip are also dry and dusty, ...without any meaningful rainfall for the past four years,... that's right, four years,... but the rains have come recently, planting has begun and area farmers are looking towards a harvest in the next several months, as well as the resultant food and water.

No,.. we haven't gone the route of veterinary medicine,... but the medical camps were held not far from livestock, and our patients didn't come through a maze of shopping malls and
housing developments to reach us. Instead they traversed open fields of grazing cattle. Quite a difference from the areas to which we're accustomed. But this is daily living for these areas in almost desperate need of health care. Areas where upper respiratory and skin infections are commonplace as is gastrointestinal worm infestation. Malnutrition and dehydration are the norm. Cardiovascular and metabolic diseases aren't seen so much since these are diseases of aging, yet some of our patients were in their 10th decade, and even as you age here, you're more inclined toward prostate, esophageal and liver cancers. Although there was one patient who was under the care of her son who was managing her diabetes, but now, they were out of money with no prospects that the closest hospital would continue to provide her insulin or her oral diabetic medication (Glucomet) without charge,... Although we happened to have a three month supply of Glucomet, the insulin would have to wait,.... We were a well stocked pharmacy, but in this area, largely devoid of electricity, we had no refrigeration, and therefore no insulin, and for that matter, neither did the patient. This son, who had managed his Mother's diabetes thus far was limited in options, but that's not unusual here,... truly, the options available are either limited or,... none.

This has been a new and quite different experience for soon to be Doctors Saomony Cheam and Tam Nguyen from the University of the Sciences in Philadelphia. When we embarked on this adventure, even I who have praticed in similar settings on many occasions, had not envisioned that this trip would involve seeing approximately 300 patients over two days in places that appear on no maps and thus are located, literally, in the middle of nowhere. These Doctors of Pharmacy have opened themselves to rare opportuinities in global health and have, over the course of the last two weeks, provided much needed medications to over 450 patients including the clinic conducted in Mtwapa, Kenya. But its much more than this. The care, compassion and hope that Drs. Cheam and Nguyen have given along with the medications they've dispensed,... that care will be enduring in this community. Amid the herds of cattle and dry, dutsy environment, these pharmacists saw the need for administering the quenching balm of hope and love, and they have more than met this need.

But this has been a trip of opened opportunites. Medical students from the University of Cincinati joined us. Elihu Godshalk and Pam Stem, forth year medical students saw patients, touched patients, prescribed for patients and in this also administered love, compassion and hope. The human touch aspect is huge here. For it is through this human contact that we are providing others with the touch that we all need as part of the human family. Its through this touch that not only affects the patients seen but also forever changes us. Elihu, Pam, Saomony and Tam have changed this community, themselves and those of us who have done this before. These soon to be Doctors of Pharmacy and Medicine have been an inspiration to all of us. For this we are thankful.

So Dr. Michael Johnson has been here before,.... the people of Sipili and Donyloip know him, have worked with him,,,, know of his compassion and passion for inspiring hope for "The Least of These". Dr. Johnson has been in Kenya for 20 years, but will be leaving soon. Will a void be felt,.. absolutely,... Will God provide another who will adminster health care to this area,.... absolutely,.. For I believe that although the Bible refers to "The least of these, my bretheren", in God's view, these are not really the least these, rather they are indeed our bretheren....and in that, they are also God's children. Dr. Johnson and his familiy have sacrificed much, in love, to be here for the last 20 years, but they, like Abraham, know that God will provide. Even to this dry and dusty plain, God will provide,... maybe especially to this dry and dusty plain, God will provide.

Amos Ooga, also was a blessing, having only recently welcomed a newborn, he and his wife are meeting the challenges of any couple married for two years. But here was Amos, a specialist in orthopedic appliances, serving on the mission field,.. a blesssing to those served, and a blessing to those with whom he served. Thank you Amos.

Then there's Anthony,... who we really couldn't do without, since he was single-handedly responsibile for our arriving safely at Nayaharuru, Laikipia, Sipili and Donyloip, as well as returning us safely to Nairobi. Anthony, a zillion thanks, especially since some of the best photos of the clinic were taken by you.

I've improved my kiswahili, somewhat,... at least conversational at the prescription window, ...mbili mara mbili kwasiku... (two tablets twice daily), ... Enjoying my time with Tam, Saomony, Michael, Elihu, Pam, Amos and Anthony. Learning much about each one and especially learning about each one's passion for service. This team is serving with joy. In our eyes, serving our bretheren,... in God's eyes, serving His children.

But there's one thing more. This team is American, Kenyan, Vietnamese, Cambodian and Jewish.... five different heritage origins. Could this be the Body of Christ? Too often we tend to segregate ourselves without reconciling ourselves in Christ or to each other. Perhaps this is what John saw in Revelations when he talks about a gathering of people from every nation and every tribe standing before the throne of the Lamb. In this team we've begun to create an assembly of service composed of people from various ethnic backgrounds,... an unlikely team perhaps, but a team in which our service to God greatly overshadows any differences we may have. Yes, these weeks have flown past, ....we've done, seen and traveled much,.. an adventure to say the least, an awesome and wonderful experience to say the most.

Four days to go, but then, who's counting :>)

Glorious Victory Academy Clinic,.... a good day?

2010-04-18T11:38:00.000-07:00

Well the announcements were made, ...the guy with the bull horn and motor scooter made his appointed rounds on a Friday afternoon. Four villages, north of Mombasa, Kenya,..Barani, Kanamai, Majengo and Porrini,.. were his areas. The medical camp was coming, 10:00 Saturday morning until 4 in the afternoon. He didn't say until the last patient was seen, because then we knew, we could be there all night (literally). But they came, mostly parents bringing sick children, some adults, but mostly children. They came,.. all 165 of them... iron deficiency anemias, upper respiratory infections, a lot of skin infections, eye infections, urinary tract infections,... they came and stayed, all of them, in the hot, humid area of this free medical camp set up by visitors from the U.S.,... a medical camp set up for those in these villages who don't see Doctors, either because they can't afford to see a Doctor or because getting to the Doctor is much too far and with a 15 or 20 kenya shilling Matatu ride out of their economic reach, access is a major problem. And so they came, with inquinal hernias, some malaria, many middle ear infections, one perforated ear drum,one schistosomiasis, and several ulcers in adults. They came because they were sick and needed care,... several patients were there who had prescriptions from governmental dispensaries, but they had no money. We treated them and provided similar medication, free of charge. Some were there because of visual difficulties,... had glasses before, .....broke them needed more,... we referred them. One patient who is HIV positive that I've been following for the past few years whose son is also HIV positive, ... both are doing well, maintaining medication regimens and visit schedules. It was a full day at what has turned into an annual event, this Glorious Victory Academy Medical Camp. The one where you can get medical examination, medication, treatment with dignity delivered with love,... and its free,... you know, ...sort of like salvation. But if people are hurting, its hard to get them to care about the saving grace of Christianity. So this clinic tries to ease their suffering with touch and care as well as examination and medicine.

Dr. Stephen Muhudhia, a close friend who often works these clinics with us, saw many of the patients. Whenever we're organizing the clinics, Dr. Steve, a pediatrician quickly agrees to assist and join in the planning. He describes the iron deficiency anemia he sees on this day,.. iron deficiany anemia caused by malnutrition. For those of us from the U.S., Steve talks about geophagia, the craving for soil, that our bodies begin to develop in situations of malnutrition. We listen and learn intently as he relates the stories he's heard,.. to us, alien stories,.. about children who literally eat dirt because they crave to do so as a result of malnutrition. We're learning, we're learning the sadness of existence in these four villages, where there is a scarity of clean drinking water, where mothers must decide which child is fed today. This is the world we're treating today.

The pharmacy students, soon to be Drs. Nguyen and Cheam, are learning too. This world is far
from the classroom they've habitated for the last six years, far even from the Native American reservations and other places of need where they've served during their recently past year of clinical rotations. But these Doctoral Candidates have sought a different plane of practice. Theirs is a mission of service to those who have severe health needs. Their vision is expanding on a daily basis, these health care professionals whose dedication to caring is becoming limitless. For me, it has been a priviledge to witness. Whereever they choose to practice, they will do so combining their professional knowledge with love and compassion. In this clinic, they operated the pharmacy under the supersion of my good friend Simon Tunje, the pharmaceutical technologist with whom I've worked for the past two years. Simon's participation in these clinics is critical since it allows me the freedom to consult with the school administration and others concerning health and educational issues pertaining to the general community.

So you could say yesterday was a good day,... we saw 165 patients, counselled many more on various life issues, distributed mosquito nets, trained pharmacy students and continued relationships within four area villages. Energized by the work, yes, you could say it was a good day. But good for whom... We get to feel good about ourselves, we who do a medical camp here once a year,.. we who get to see a Doctor whenever we want,.. we who get to go home to the U.S. Was this a good day for the many who suffer daily from malnutrition? Was this a good day for the mother who told me her daughter would like to transfer to another secondary school but can't for lack of school fees, or the mother whose mud dwelling that had been three rooms is now one room because of the severe rains. While our organization (Bibles, Books and Shovels) has an ongoing relationship with these communities, people continue to have daily struggles, but nonetheless seek good days. So we dispense our medicines, examine our patients and try to infuse some "goodness" into this day. But can we really? In an area where many days just aren't so good?

Steve Muhudhia once told me that those who think they're dispensing pills and cough syrups only, are missing the point. Dr. Muhudhia, a Kenyan well familiar with medical outreach ministries, explained that when medicines are brought and patients are seen and cared for with love, kindness and compassion, along the pills and cough syrup, is a giant dose of hope and knowledge, ...knowledge that there is someone who cares, hope that perhaps the children can aspire to a better life, hope that, although governments may not care or provide basic needs for their citizens, there are those who do (care), and will hold the governments accountable, even as they are dispensing pills and cough syrups.

John the Baptist, while in prison, enduring his own suffering that didn't feel so good, and knowing of others' continued struggles,..sent his disciples to ask Jesus if He was the one they had been waiting for,.. was He, in fact, the Christ,.. Jesus replied, ...you go tell John that the lame walk, the blind see, the good news has been preached to the poor..... I think he may have been saying that, yes, suffering still exists, and will continue to exist, but now there is a sense of hope because they've seen and heard the good news of physical and spiritual healing through compassion and love. Whatever it is that we do, our call is to be that good news, through our actions, as well as our words. If we do that, then everyone may be able to say "Yes, this has been a good day".

Dad

2010-04-15T12:54:00.000-07:00

Ok, Ok, so I'm a bit nostalgic, some might say. Others might be a little less kind and say I'm hallucinating. Still others would say,... well, ... maybe,... a little,... But if you look closely at the picture to the left, this man who was kind enough to allow his picture to be taken by a stranger, and one with an American Accent at that, this man, bears a striking resemblance to my Dad. I've heard it said, although I don't know by whom, and I'm not sure I believe it, that all of us has someone in this universe that we can claim kinship with as a look-alike, not related by blood. I haven't found mine yet, but I'm in Kenya and I've found my father's look-alike,... Go on, take a close look, or maybe you don't have to look that hard. This man is a carbon copy of ..The man.

So you might say, Neil c'mon, you're way over the top on this, and I would say,.. look,... I was at a petrol station where we had stopped to have our radiator hose repaired on the aforemention State-of-The-Art Toyota (see previous post), walking along, minding my own business, when out of the corner of my eye, off to the left, I spy a gentleman, probably the owner of the petrol station, sitting in a chair, and sitting as only my Dad could sit,... those of you who knew him won't need an explanation,..those of you who didn't,.. well, its hard to explain anyway. So I walk closer, and he begins to rise from the chair as only my Dad could rise, and walk as only he could walk,... and, ...I'm not making this up,.. when I asked to take his picture, he sounded like,... that's right. And the most amazing thing,... when he posed for the picture leaning on a car parked outside the petrol station's bay,... he stood like The Man. Even had his shirt open at the collar,... I tell you it was uncanny and a bit spooky,.. don't know how else to describe it.

We live in a small world,... so small that I think we're connected by the tiniest of threads, the most stunning coincidences, the strangest circumstances, that at the most unexpected moments capture our attention and bind us together as the human family we really are. I saw this gentleman for the quickest of 15 minutes, and we were bound for that 15 minutes through his likeness of my father and willingness to have his picture taken because of that. He expressed flattery when asked for his picture and a silent joy when told that he looked like someone that I love. Eerily, the same type of silent joy my father often expressed in similar circumstances, and in that, we found relationship,... for a brief 15 minutes perhaps, but I'll remember those 15 minutes for quite awhile.

So, whenever you're out and about, minding your own business, be on the lookout for that strange set of circumstances that could provoke you to think about how you're linked to your neighbor in very real, yet unexpected ways. Of course some of us may not want to be linked to our neighbor,... but I'll save that one for later. As for me, .. I just felt like yelling, "Hey Dad,.. wait up" :>)

On the lighter side,.... roadside justice?

2010-04-12T01:33:00.000-07:00

Cruising along on our way to Kisumu, me, my good friends Rose and Keith, their children, Rose's Mother and Brother, heading out of Nairobi for our next big city destination, Nakuru. The vehicle is rather dated, well, not so much dated as it is just out of shape. In fact, you might hear it blocks before you actually see it. Basically, its a minibus, seats 14 with pop-up roof intended for safari park excursions. It has a crack in the windshield, spews volumes and volumes of dark exhaust (and its passed emissions inspection, if that tells you anything about vehicular inspections in Kenya), the passenger seatbelt doesn't work and it has no shock absorbers (that I could detect anyway). Its a Toyota. But don't let any of these minor flaws mislead you. This car is sound. This car navigates pot holes and speed bumps that would make a lesser car, plead for mercy. Say what you will about Toyota, but I'm convinced that they manufacture vehicles specifically made for Kenyan roads. I've been on other road trips in Kenya where you just knew you were going to break an axle. But no way. These cars withstand the nastiest of road conditions and road deterioration and no roads, for that matter. My Highlander would have been trashed long ago. I'm a BIG fan of Toyota in Kenya. Not to mention that it takes its occupants to the brink and back (Kisumu) and they live to tell the tale. Thank you Toyota.

Anyway, we're cruising along when we're flagged down by the Roadside Police. One thing you have to know is that in Kenya, few police have cars. They'll flag you down, arrest you for some fictitious violation and then say, "Drive me to the police station." That is, if you're arrested. Most of the time, the'll inspect your car, at roadside, fine you and then collect the fine, at roadside. One stop shopping has a whole new meaning. So we were stopped, which, by the way is a routine occurrence in Kenya, fined 400 kenya shillings (a little over $5.00 U.S.) and then sent on our way. Keith says the infraction was the cracked windshield. Now, we could be stopped again and fined for the same cracked windshield (as it turns out we weren't but there are no guarentees). Bear in mind that, if we hadn't paid the "fine" at roadside, we would have received a summons to apear in court to receive an even heftier fine. So this is roadside justice,... its quick, usually painless, if somewhat annoying, and cheap compared to the alternative. Courtroom justice would have cost more in money and time. By the way, the word "justice" is purely incidental. It fills space, nothing more,.. though it could easily be called roadside "hassle". How about roadside injustice? And of course, let's just say the 400 kenya shillings doesn't go to the municpal treasury. Its really very funny once you get used to it,... you just build the time into your day, and you have no worries. Its all about expectations (you should expect to be stopped). So the next time you're in Kenya, better be sure to carry around an extra 1000 bob,.. you never know when you'll need it, lest you hear the words,.."you're under arrest,... drive us to the police station."

The Lecture

2010-04-11T13:42:00.000-07:00

So I gave a lecture at the University of Nairobi, College of Health Sciences. I was invited to talk on the issue of Clinical Pharmacy and the role of the clinical pharamcist as a member of the healthcare team. The title of my talk: Current and Emerging Trends in Clinical Pharmacy: Integration of the Pharmacist as Health Team Member. In the audience were professors from the various healthcare disciplines, noted names in their various fields in Kenya, including highly respected professors of pharmacy, representatives from the Kenyan Ministry of Health, and the Kenyan Poisons and Pharmacy Board (the Kenyan FDA equivalent), and what seemed to be the entire student body of the University of Nairobi school of pharmacy. All of these individuals want to make a difference in health care in Kenya and all strive to bring pharmacy to the forefront of that paradigm shift in Kenyan healthcare. Further, it seems to be the concensus that the University of Nairobi, College of Health Sciences should be among the leaders of advancing healthcare in this country, if not the leader. So there I was, presenting my views on where the profession of pharmacy could go in Kenya, and how the profession can bring about meaningful change in Kenyan healthcare. The Gospel according to Neil...:>). or maybe an Epistle, 21st century style, by powerpoint. Of course my tongue is planted firmly in my cheek; I was humbled by the experience.

In any case, Kenyan training in the healthsciences is, in many if not most cases, more advanced than some U.S. schools of the healthsciences. Their thinking is quite progressive, their attitudes are very positive, their overall position is that we, as healthcare scientists, particularly pharmacists, have a rightful place among the healthcare elite of this country, and it is our obligation to be the authors of change,.... for all Kenyans. But, in this country of approximately 40 million, there is rampant HIV/AIDS, epidemic malaria, particularly in coastal areas, nutritional problems abound, with hunger, starvation and dehydration leading the causes of death in children. The issues of poverty as the primary factor in all of these circumstances is huge with most working individuals livng on $1.00 per day. So why is it that in a country of such forward thinking health professionals, AIDS and its accompanying deaths, exists at record prevalance, dehydrated children die routinely, malaria still kills the most vulnerable, and in its most remote areas, there are no physicians, no pharmacists, no medications and almost nothing that bears the slightest resemblance to regularly administered modern healthcare.

Several years ago, while walking on a gravelly/dirt path towards the main road, in a small Kenyan village, I asked my host, "What happens when someone gets sick back here". He smiled the kind of smile usually given to someone who has asked the most nieve of questions,..and replied simply," they die." Over the years, in other remote areas of Kenya, I've asked the same question, and the answer has always been the same,...."they die,...,of the simplest malady,... "they die." Of the most uncomplicated respiratory or cardiovascular disorder,..."they die". But wait a minute,... we have forward thinking health professionals,.. people who boldly state their intention to innovatively treat disease. People with uncomplicated disease are not supposed to die prematurely.

The universal tragedy is that this is not a story unique to Kenya. In many of our "developed" countries, there are those who die, needlessly, because "innovative healthcare" is not synonomous with the term "equally available healthcare", and even with U.S. healthcare reform, and the availability of insurance for an additional 32 million individuals, we are left questioning if that insurance will provide innovative healthcare to all. My mother who may have been diagnosed with cancer may not be offered state of the art treatments without the appropriate insurance, and what's even more tragic, is that investigations required to render an accurate diagnosis, may not even be ordered until the cancer is in its late stages,... because my mother may not have an insurance program that will pay for state of the art diagnosis and treatment, ...y'know,... the treatments that are seen on Fox Chase Cancer Hospital commercials. Or, my mother, because of the color of her skin, or perceived social background, may be seen as not worthy of elite care that would be offered to others of higher social or economic background. So, I wouldn't get too overjoyed about the new U.S. healthcare proposals until we have a sense of how the new legislation incorporates, in very specific terms, the dignity that one human being affords another,... or until the newly enacted laws state how we should relate to each other as the community that we really are. So, of course, Kenya doesn't have a monoply on poorly and unequally disseminated healthcare. We all share pieces of this tragedy.

Nevertheless, I incorporated some of this in my talk last week, calling on those in the audience to truly advocate for adequate and evenly distributaed healthcare for all Kenyans (especially those in the slums where we've often treated patients). It seemed very well received, and judging from the optimistic views of the students, their overall idealism as well as ambitious thoughts on healthcare provision, there is abundant reason to be hopeful that in future generations this change will come about. These Kenyans seem more than committed to the meet the challenges and engage in the difficult work that change will require. Their dedication to this could allow them to make the difference in providing healthcare for all Kenyans, in a way that affords uplifting the human spirit, allowing human dignity to flourish and dispenses hope along with medication. Now if that hope and committment for equality in healthcare reaches the world, the term Universal Health Care could take on its true meaning. Archeologist have said that civilization began in East Africa. Maybe the rebirth we need for global equally disseminated healthcare will begin in East Africa as well.

But on the bright side,...

2010-04-09T19:41:00.000-07:00

Our World Gospel Missions colleagues are in Malindi on retreat for the next week. Before leaving, Dr. Johnson was asked to admit a child from Imani orphange to St. Mary's Hospital. The transporter of the child had not yet arrived and so Michael provided a note to me to convey to the driver authorizing the child's admission. Upon leaving, Michael comments,
"Oh by the way, I've referred another child to you."
" Don't worry Michael, the driver has already been here and he has the note, so, he's on his way to the hospital"
"No, this is another child. Faith (from Imani), called me this morning and she's sending another child, I gave them your number so you could admit them, just sign the note for 'The Least of These' (his organization for providing care). "I told them Dr. Pitts would admit the child since I wouldn't be here."
"Oh thanks Michael, Now I have admitting privileges."
"Well, after you've been here two weeks, you're in charge"

Such is life at St. Mary's hospital, even visiting health care professionals lend a hand at providing care for those who may not have access either because of distance, finances or both. As it turns out, this child was the son of Faith's friend, Maureen, who had already gone to Kenyatta National Hospital because her child had been experiencing seizures every hour since 4:00 a.m. But because she is aware of the care and personal attention the child will receive at St. Mary's she called Dr. Johnson, and then, me.

Ian Josh, 3 1/2 years old, was seen almost immediately at St. Mary's and it was at first suspected that he had menningitis. Although he hadn't had a seizure for the last 2 hours and his temperature was normal at the time, menningitis is suspected in cases where the child doesn't have a history of convulsive activity. In addition to the mother and father, Ian is accompanied by his grandmother who happens to be a retired nurse and was tracking symptoms and current course of events well. The child had recently experienced pneumonia, had been hospitalized, treated and released from Kenyatta during the course of the past two weeks, had finished discharge meds, but now had a different problem,... these new onset convulsions, of seemingly unknown origin.

The pediatrician, Dr. Kimani was wise, patient and kind,.. a great combination of personal attributes when seeing patients at St. Mary's. Upon inquiring about the patient's history, it is determined that these current episodes may be due to high fever. Even in our country, children have seizures of this type. Nonetheless an EEG is ordered, phenobarital is prescribed and the child and family are sent home. When I called to follow-up that evening, Ian hadn't experienced further seizures and was sleeping, no surprise since he had had several doses of phenobarbital that day (for emergency and acute treatment of the seizures). When Ian's Mother, Maureen, called the next day, Ian was doing well, still experiencing no further symptoms.

So, there is a bright side and, for most situations, good outcomes for cases at St. Mary's,.. not all children remain in the hospital and not all children die. Although we still don't know whether or not Ian has epilepsy, the EEG will provide further information, we do know that he was seen with compassion and love, by all who attended him. Isn't this what we're supposed to do?

As for my admitting priviledges, I hope they're short lived,.... but then again,..whenever we're asked to 'stand in the gap' for 'The Least of These', we all have admitting priviledges to offer our neighbors a higher quality of life.

I have...only questions

2010-04-07T12:35:00.000-07:00

Three young men, one physician and one pharmacist are gathered in an office in the physician's home in Nairobi, Kenya one afternnon in April. The three young men were looking for news, mostly good news, that their father, in the late stages of liver cancer could be offered some hope for a longer life. The 60 year old carpenter has become excessively weak in the past several days. The three young men are just the oldest of this man's progeny, and seemly, the spokesmen for the family. Alarmed at the deteriorating condition of the father, they come to the physician's house with a plea that something can be done to sustain the father's life.

There is hope in their eyes although a despair in their body language. Seated on benches and chairs in the office, they are bent with hands cupping faces, weighted by the burden of uncertainty, wondering what words of assurance will be provided. The physician has seen the father's X-rays and shows signs of internal struggle as he looks for words to express his truth. That the father will die from this cancer is certain... when?.. is less clear. How to tell these devoted sons is difficult and unclear. The words come slowly and with compassion, but they come. "The best course for your father at this point is hospice care. " Your father can be made comfortable in his final days. "This is time for refelction and reconcilliation with family members", says the physician. "There are no effective treatments".

When we hear those words, where do we turn? When you are told that your 60 year old father will not live much longer, how do you fit those words into your life. The sadness of Kenya is that 60 years old is beyond the average life expectancy by several years, and so, this father was living in excess of his allotted time. But isn't that still 18 years too short? Isn't that 10 years below our conception of a "normal" lifespan? I have no answers, only questions.

These young men, Daniel, Simon and Peter, will soon loose their father at the age of 60 years old. The physician and pharmacist, good friends and co-workers in missions, deliver the bad news with compassion and sympathy, tempered with an attempt at hope that at least the father's pain can be relieved. Through consultation with each other, the pharmacist and physician offer morphine as a way of mitigating the father's pain, ..but who will mitigate the pain of these sons? Who will offer relieve for the Mother who will soon loose her mate, or the twin sisters and youngest brother, who at 22, will be fatherless? It seems shallow at times to say that God relieves our suffering, although he does. It can sound insincere and empty to suggest that God lifts our fears of the unknown, although he has promised to do that. The morphine the pharmacist recommends will be unable to sooth the emptyness and the soon to appear void of the father's loss... What can we offer them, other than prayer,.. which we offer? I have no answers,....only questions.

Pasaka

2010-04-04T12:41:00.000-07:00

At 4:00 a.m., Pasaka Imani died. He was 3 months old, we think. The cause of death: severe dehydration. He leaves to mourn, the hospital familiy that cared for him in his final hours. His Father: unknown. His mother: Unknown. He was pre-deceased by his "brother", Bonaventure Imani, also aged 3 months, we think. So maybe we did need lipid and high calorie fluids to save his life. Throw away lives,... no one to grieve. As I watched his empty bed Sunday morning, I could only think of what may have been had he lived. The story of his life is short though and we can only grieve for his extended human family that allowed Pasaka's death at 4:00 this morning. While we slept, he died. There is nothing left to say.

An ordinary circumstance...

2010-04-03T11:15:00.000-07:00

The woman brought the tiny bundle into St. Mary's Hospital pediatric ward. The child was still,.. pale,... emaciated, ...but alive. Quickly he was given Lactated Ringers intravenous solution. Ordinarily, a child brought to an American hospital would have been given intravenous lipid emulsions and total parenteral nutrition, the life saving, calorie rendering nutrients we administer in the U.S. healthcare system. As a sterile products pharmacist, I've prepared many of these life giving fluids. I've seen the miracle these medications can deliver. Under ordinary circumstances this child would be in the nursery intensive care unit. Urgent action would have been taken to measure vital signs, to determine weight, nutritional needs and weather or not social worker intervention was needed. Under ordinary circumstances this child would have been placed in an incubator with all modern bio-technology available and ready for use to revitalize an infant who was near death. Under ordinary circumstances. But this wasn't an ordinary circumstance. This child brought in by a woman, not his mother, but a woman worker at Imani Orphanage. Only doing her job and just carrying and delivering a package given to her by yet another (anonymous) person delivering this package found abandoned somewhere in Nairobi. The package? ... a barely breathing tiny human being. A child destined for St. Mary's Missions Hospital Pediatric ward on this Good Friday evening. By our western, civilized standards, this is no ordinary circumstance. For East sub-saharan Africa, it is all too ordinary. A child abandoned, a child found, a child delivered to a missions hospital, a child who died. No, we don't know the mother, a woman who doesn't know the fate of her child. We only know that on this Good Friday Evening, this child, God's child, has left no one to mourn except a hospital staff who has Lactated Ringers and a small gurney for this child to spend his final moments. Oh, and we didn't know his name,.. but we do know he died on the same day that we commemorate the death of Jesus. So maybe we can envision Jesus, you know, the guy who said, "Today you will be with me in Paradise", receiving this infant child into His bosom, and in that, there is good fortune for this child at the end of this ordinary circumstance. So let's call him Bonaventure,... child of good fortune.

Then there is Pasaka, also nameless, but called Pasaka by Dr. Johnson the M.D. on call. Pasaka is kiswahi for Easter. Earlier in the day, Pasaka was also brought in from Imani orphanage after being found abandoned somewhere in Nairobi. Also given an electrolyte and salt solution, as was Bonaventure, but Pasaka has so far survived the torments of dehydration and malnourishment. Even without an incubator or high fat/high calorie fluids, Pasaka lives on this Easter eve,..as Jesus lives.

Life in any circumstance, in any environment, is tenuous. We all live by the day, if not the hour. In Kenya, life occurs sometimes in minutes. These two children were brought to St. Mary's Hospital hours apart,... one lives, the other dies. One child will return to a home, even if its an orphanage,... the other spent the night in a hospital mortuary. Jesus said "Suffer the little children to come unto me and forbid them not, for such is the Kingdom of Heaven. In Kenya, it seems that it is ordinary for children to suffer abandonment, dehydration and malnutrition, all products of extreme poverty, and in this we forbid them from coming into God's kingdom here on earth and life plays itself out sometimes in the hours and the minutes. Life is tenuous and random it seems. Its a matter of time and a matter of place, for if you were born in Kenya and don't arrive from the orphange in time, you could die.

So,... thus far in my most recent visit to Kenya (I've only been here for two weeks), we've seen two children die, unnecessarly,... a pleathora of assorted cancers and infections,... and untold numbers of suffering human beings that would not suffer,... under "ordinary" circumstances. During the Easter season, our ordinary circumstance is that traditionally, our children wear new suits and dresses to Church to sing praises to Jesus. Generally, we don't think about dying children. This Easter, as I sing praises to Jesus, Bonaventure and Pasaka have taught me about death and resurrected life in its real sense,... its close, and its personal. The way Jesus wants to relate to me. If we are open to God's lessons, the death of one infant on Good Friday, and the revitalization of another on Easter Sunday, can have profound,... and lasting impact. An ordinary circumstance at St. Mary's Hospital in Nairobi, Kenya,....A profound and extraordinary implication for how we live our Christianity.

Kibera,..... Lord, you know that I love you..... Really!!??

2010-03-27T11:34:00.000-07:00

So, imagine you're one of about 1.2 million people (and by some estimates, up to 3 million) in a community, and immediately adjacent to your home is a stream. It has rained the previous night and the stream is overflowing,... y'know, similar to your local river after the torrents have come. Downstream, a goat has relieved itself in the water that feeds your brook. You have to go to work, presuming you can find work, and your children have to go to school crossing the footbridge outside your "backyard" that crosses the stream, that the goat has relieved itself in. You step nimbly across the muddy footbridge, one foot across the other, -- you do this everyday-- and you and your children are on your way to find work and to go to school. Stepping through mud across the refuse and sewage as you make your way ot the main road, you greet others along the way,.. "jambo, habari gani?",... "mzuri sana, na wewe?" is the reply and you in turn respond, "mzuri sana", very well. But is it well? Kibera, perhaps the world's largest slum in the center of Nairobi, Kenya is home to the worst poverty on this planet. There are more routinely stories of disease, teen pregnancy, unclean water, no sanitary conditions or electricity, than not,.. all in an area 2 km square containing 10 villages. Today we trampled, climbed, slid and otherwise journeyed through three of these villages: Gatwakera, Soweto and Kianda. These 1.2 million people live here, I get to go home and eat a nice meal. The children, play here, amidst the unsanitary conditions, sometimes falling as they do, but these conditions are alien to my children. "How are you?" is the song heard as the visitors pass many smiles ripe for picture taking. But this is not a pretty picture and we woudn't be smiling if we lived here. As we walk, replying to the greetings we receive and returning the smiles, our hearts are heavy as is the dusty air, and as we continue on, our allergies are affected,.. our eyes begin to water,... tears of allergy,.. or are we crying for Kibera?

My kids, their kids, they're all God's kids, and regardless of where they were born, should anyone "live" like this? Susan Werner's Gospel Project says it well: "When I close my eyes so I would not see,.. my Lord did trouble me. When I let things stand that should not be, my Lord did trouble me. " Not enough of us are troubled when see this, or, too many of us close our eyes. The problems of Kibera and Mathare Valley and other places are too numerous to mention or think about much less solve, but this generation can at least begin the process. We fight over strips of land in Palestine and Israel, when the land we should be concerned about lanquishes in poverty and desperate need. The war on which we need to concentrate is one that combats disease, homelessness and other elements of poverty while claiming human dignity as the victory prize. We decry abortion while allowing those born to exist in squallor. Do you want this for your children? Perhaps the answer is obvious, but we have turned away from many obvious answers while neighbors suffer and die. Jesus said, the poor will always be with you because he knew that without Him, we'd turn away,... like we turned away from Him. He also said, that we should "love each other as I have loved you", and He knew that without Him, we wouldn't do this, yet we say we reciprocate the love He has for us. "Lord you know all things, you know that I love you." Do we really? So, maybe the key is that Jesus needs to be in the love we extend to each other and in the eradication of poverty. Smart man, that Jesus. If we want to be like Jesus, and He didn't turn away from the poor, why do we? Can we hold all children in our hearts, the way Jesus holds us in His? Do we really love and want to be,... like Jesus?

The road to nowhere?

2010-03-25T13:39:00.000-07:00

Just returned to Nairobi from Ruai... Now if you've never heard of Ruai, it might be because 'you can't get there from here'. Oh, Ruai has much life to it and plenty of people, ...not like its a deserted small town (although compared to Nairobi, its miniscule). But the roads we were on,-- and roads is a very generous term,-- the travel and the smaller towns and communities, were a little reminiscent of an Indiana Jones adventure, and now, ...Cat Stevens' "Road to Nowhere" springs to mind. But this road to nowhere, --first becoming quite narrow, then dissolving into tracks of mud--evaporates completely into about 1600 acres of grassy and very often muddy Kenyan plains that, by June 2011, my fellow travelers say, will begin to take shape as a community of homes, shops, a hospital/medical training center, a postal office, complete with electricity and clean running water (rare in these parts). Now, this place is home to cattle, Nomadic Masai tribes, a few empty brick dwellings dotting the landscape, whose completion was clearly postponed due to lack of funding. Here, there is no tapped electricity, no clean running water, no medical care or other amenities usually associated with sustained healthy community living. But the 11 men I'm traveling with on this bright Kenyan afternoon have a vision, a blue print, the courage and the faith resources to breathe life into this Kenyan plain.

There are many excellent projects on the African continent that are inspiring, courageous, and with abundant vision. Africa is not a place where sadness abounds. Even within areas of desperate poverty, there is contageous hope. All too frequently though, we miss that which uplifts and report that which provokes feelings of sorrow, leaving us with a picture of Africa as an area of civil war, drought, famine and despair. But the balance is, that African citizens have refused, for centuries, to succumb to the images and perceptions of a world determined to undermine its vast sea of inner spirit, confidence and strength for revival. And so, the 12 of us gather on this dusty, muddy and grassy plain to visualize a community where hope lives in abundant supply. Such a community could serve as a model for changing the world's perception of a place that refuses to be forgotten. This community and those giving it birth, could be the impetus for changing a continent.

Jesus said to His 12, Follow me, and I will make you fishers of men. Through following a vision for this City of Hope, are these 12, assembled here this afternoon, living the reality of becoming fishers of men, encouraging the human spirit, attempting to redirect our human destiny? We can do no less than to follow Christ and His vision and desire for a wholistic and healthy society. It appears that these 12 may be realizing that. These 12 may be answering Jesus' call to follow him. Isn't this the call that all of us should answer? Maybe the road doesn't have to lead to nowhere.

Choices, choices, choices

2010-03-24T12:15:00.000-07:00

Victor was just under two years old, or maybe he was just over two,... didn't say much, so we couldn't ask him and its otherwise hard to tell his exact age. And there's no one to ask,... they're all busy doing other things. Can't say where his parents are, so its a bit strange that this little boy is laying on the examining table, peaceful but alone, with the flurry of activity around him and in other parts of this room.

Leaving Victor, we walk past a woman, Maria, laying on a gourney, alive,.. although barely,.. weak and pale, also not saying much, a bit more activity though, but most people are in other parts of this room doing other things. Its seems the real action was not with Maria or Victor but in another direction of the room where I.V.s were quickly hung, electrolyte solutions rapidly opened with the accompanying background sounds of groaning and crying and an atmosphere of urgency, without which people would die.

From one table to the next we move past the half-dead and almost dead human beings in the re-hydration room of St. Mary's Missions Hospital in Nairobi, Kenya. Water and food are precious commodities here and if you don't get enough of either, you will be faced with the very real possibility of dehydration. Or maybe the real enemy you face is diarrhea. Dehydration and electrolyte depletion are close cousins, and there's a home for you here, in the re-hydration room, if not comfort and healing. Hence the I.V. fluids and electrolyte solutions. So, we live in a world composed of 75% water, yet we need a rehydration room. Seems like and oxymoronic situation. And its not so much that there isn't sufficient water, ..there is. Its a matter that on this planet, resources have not been directed to insure that the water is kept clean. And in areas of drought, efforts are not made to bring fresh water to those in need. Even in the end, in a re-hydration room in sub-saharan Africa, human resources are so diminished that we choose to attend to those who might survive rather that attempt revival of those who we know won't.

So there lays Maria, not her real name but perhaps a suitable one, on the half-dead or almost dead list. Maybe she'll find renewed life, maybe she won't. Her groans are muffled and becoming softer and her breathing more shallow, as attendants rush past her to save those they can. Choices, choices, choices,....Oh yeah, and as for Victor, the almost two year old, he's already dead, so that's one less choice that will have to be made. And by the way, we never knew his real name, but made the choice to call him Victor. We don't know his real life story, but if you die at the age of two in a re-hydration room, in Nairobi, Kenya, because diarrhea has literally drained the life from you, it seems appropriate that 'Victory' should in some way be attached to your humanity.

We've made the choice to allow much of our planetary population to suffer for lack of clean water or adequate nourishment. We've made the choice to allow many of our neighbors to die, even two year olds, because of it. Paul Tillich has suggested that we impune the credibility of our Christianity when we worship a child born in a manger over 2,000 years ago, yet allow two year olds to die needlessly, today. Could it be that in this, we've made the choice to compromise our planetary humanity?

World Health (Originally posted 2/16/2010)

2010-03-14T05:08:00.000-07:00

A new site featuring health from around the planet,... even something for Francophiles (RFI Health News),.. a regular feature of this blog (see Health Links), but for quick access, you can see it here. Check it out,..http://pharmacistforafrica.com/

Play Ball (Originally posted 2/13/2010)

2010-03-14T05:05:00.000-07:00

Six days, 4 hours and 18 minutes,,, not that I’m counting, ‘till spring training starts. Just heard that more snow is expected next week,,… don’t know if its fact or rumor, but either way, I think we’re about ready for at least the hint of warmth. So here it is. Spring training is on the way. February 17, 2010, coincidentally my birthday, pitchers and catchers for the Philadelphia Phillies, will report to Clearwater Florida for the start of this year’s spring ritual. Play Ball!! Now if you think this is a bit over the top, consider that this has been the snowiest winter in Philadelphia record keeping history. Yesterday Interstates 76, and 676 were closed, as was MLK and Kelly Drives. Major Universities were shut down, not that the students objected, but that has got to be a first. And so on to the big dig,,.. where are our cars?,.. WHERE ARE OUR CARS?? ,.. need a backhoe just to free ourselves from the imprisonment of our driveways..Now, I’m not complaining, its just that, in my old age I now realize why my father couldn’t wait to head south and take up residence in warmer climes. At the ripe “old” age of 76 he built a homestead in Lehigh Acres, Florida. But he came by it honestly,… my grandparents pulled up stakes and headed for Riverside, California when both were 86. So I can blame it on genes and I guess I have a “sunny” future to look forward to,… no pun intended,.. actually I did intend that,… But anyway, its time to think warm. Let’s imagine putting away the snow blowers and shovels. For me, I have tulips in my house as a reminder that spring can’t be far off. The thought of spring training, the sound of cheering crowds and visions of umpires dance in our heads with sights of 6 feet snow drifts, a distant dream. Bring on the ticket takers and the Philly Phanatic and let’s… Play Ball!!

Speaking of contrasts,...(Originally posted 2/10/2010)

2010-03-14T05:01:00.000-07:00

So,.. its 32 degrees F. in Philly, snowy, ...already 8 inches has fallen over the last 12 hours with more on the way,.. and this following the 28 inches from last weekend. In the meantime, in Haiti its 86 degrees, partly cloudly and humid, a slight threat of rain, .. quite a contrasting picture of nature at work,... not the only contrast though. This island nation is still in the tight grasp of extreme poverty, illness and suffering. On of our major concerns in the mid-Atlantic U.S., centers on digging from under the snow. Their major concern centers on digging from under the rubble and poverty that has buried much of the country. Hunger and health care are prime concerns,.. living from day-to-day is a prime concern, ....survival and where to bury the dead are prime concerns, ..all following the massive earthquake that devastated the already weakened infrastructure and has left hundreds of thousands in need of a home, food, health care or a hug. Where do orphaned children find a home, or a Mother, her missing child? Quite a contrast indeed.

And so my good friend, Michael Johnson, boarded a plane in Philadelphia yesterday, made his way to Ft. Lauderdale FL and is now enroute to Port au Prince Haiti on a plane he describes as a "cargo transport with seats". Michael is a surgeon with his primary practice in Nairobi, Kenya. He's used to contrasts. Amidst the palm trees of Nairobi, he's used to seeing suffering of the highest magnitude. Working within a tropical climate, he's become accustomed to hearing the groans of the poor. Within corrupt governmental structures, he's acclimated to watching unnecessary death. Or has he? In developed nations, we take for granted the "luxuries" afforded us by our systems. The human rights we enjoy have eroded our sensibilities such that we become negectfully blind to our neighbors circumstance and need,... even when our neighbor is the island a few doors down the block. But then again, we do that when our neighbor literally lives on our block. But when we truly care, is it possible to ever become habituated when our neighbor hurts?

So Dr. Michael Johnson is traveling with 21 others on "Missionary Flights International" to Haiti. Unnecessary suffering, for them, has not been accepted as the norm. When they reach Port au Prince, they are sure to witness the vast array of needs that have plagued this island country for centuries. Michael is sure to be confronted with the lack of infrastructure that will prevent him from a straightforward route to the hospital where he's needed. The starvation of the country is guarenteed to greet them upon arrival. There is little doubt that these missionaries will use their gifts to care for someone before they exit the vicinity of the airport. Let our prayers and thoughts be with them. They serve with love and compassion.

Jesus talked about healing repeatedly,.. and looking closely at this, perhaps our human commonality is in the healing we all seek. And so while there are contrasts of weather and the diversity of climatic events, congruity can be the result of healing. Physicians may physically provide healing to the sick, but can receive healing through the hope and love provided by the human spirit. And maybe this is what we see in Haiti and other places in the world: Healing and hope become mutually exchanged commodities, ...contrasts yield to similarities, and we find that we can love and care for our neighbors. All we have to do, is get out of the way. Contrasts?... What contrasts?

The size of our minds (Originally posted 2/6/2010)

2010-03-14T04:58:00.000-07:00

Let's think BIG in the name of Jesus. Sometimes we, as human beings, think on a small scale in or Ministries and service to Jesus. Are we afraid of the power He could unleash in our lives, if we were truly to believe in, and practice His greatness. I'm not convinced that when we live in our smallness, we honor His greatness.. Its true, we are finite creatures, but can we, in that limited nature, tap into His infinitude through our faith. He did say, "If I be lifted up from the earth, I'll draw all men (and women) unto me" (John 12:32). What, exactly, did he mean by this? Was Paul giving us a clue as to what we can become in Jesus when he said "I can do all things through Christ who strengthens me" (Phillipians 4:13). Let's check out this sermon www.inglewoodfirstpres.org/Think_Big_for_Jesus.htm

Answering the call (Originally posted 1/13/2010)

2010-03-14T04:55:00.000-07:00

What a tragedy,..Can you imagine, .. its almost dusk, the ground opens up beneath you, your world begins to crumble around you, literally, and you have no governmental infrastructure, no equipment, little food, no clean water. Night falls, and now, there are no lights. Imagine the long and frightening night of aftershocks, fearful that the next one could be even more devastating than the last. The cries for help and the prayers permeate the dust laden air as you begin to realize that even the closest assistance is countries away. Imagine this at the end of your day. After making your dollar. Its only a matter of where you were born that separates the "developed" world from underdeveloped nations. Only a matter of geography that even the poorest of the poor are faced with even greater physical devastation. On this planet of almost 7 billion, we are called to help our neighbors, regardless of location. In Haiti, as with those victims of Tsunami's in Asia, the call is among this planet's loudest. Will you ignore the weeping of the desperate?... Would Jesus? An organization based in Philadelphia, PA is answering the call, as many are. Visit the website of "Lamp for Haiti" to learn how you can help you neighbor. Will you answer the call? http://www.lampforhaiti.org/

Is it Spring yet? (Originally posted 1/2010)

2010-03-14T04:52:00.000-07:00

Ok, Ok, ready for the cold to end? If you want to know what's hot today,.. its not Philadelphia, nor Florida or even L.A. where its currently 53 degrees F. But even that's a heatwave compared to Philly where its 17 degrees F. But hey,. its all perspective,.. In Duluth, MN its 2.5F with wind chills of -13F.. (wonder what that is in Kelvin?),.. some serious cold. Brrr!!!! Do prarie dogs have space heaters?

The meaning of intellegence

2010-03-14T04:50:00.000-07:00

The Meaning of intellegence,... an insightful discussion presented on NPR's "Speaking of Faith" concerning the multitude of educational classifications in our society,.. many of which speak of the "social predestination" described by social commentator John Lewis. An interesting analysis of education in America and the "No Child Left Behind" legislation has been written by Mike Rose. Check it out in "Speaking of Service" side panel.

Can you understand this? (Originally posted 1/10/2010)

2010-03-14T04:46:00.000-07:00

Just found a comprehensive link describing the current health reform debate and legislation. Trying to understand it all. Roses to anyone who beats me to it. See Kaiser Family Foundation in Health Links in side panel

So, when was this written (originally poste 1/7/2010)

2010-03-14T04:43:00.000-07:00

Dateline Egypt, Jan 7, 2010,.. The Egyptian Ambassador to UAE, Tamir Mansour, conveyed the congratulations of Egyptian President Mohamed Hosni Mubarak to the coptic living in the UAE and his appreciation of the UAE religious tolerance, security and stability the Egyptian community - both Muslims and Christians - are enjoying. Addressing the Mass, Religious and Judicial Advisor at the Ministry of Presidential Affairs Ali Al Hashemi said both teachings of Islam and Christianity promote noble values of good, love and peace. He also highlighted the religious and moral approach the UAE is following in its domestic and foreign policy. Seems ironic and antithetical since at the about the same time, if not earlier, a Muslim was killing coptic Christians at a Christmas service. Now its true that one act of violence doesn't a pattern make, or doesn't define a people,.. but,.. when Muslims don't act like Muslims according to the Koran, and Christians don't act like Christians according to the Gospels, where are we headed?.. What do you think? Read about it in Voice of America (Middle East) in the side panel.

Watching your health (originally posted 1/21/2010)

2010-03-14T04:30:00.000-07:00

So, 2010 promises to be a busy year for health events. Already the NAACP and Greater Philadelphia Health Alliance (GPHA) are kicking off their year with two health fairs. Blood Pressure, Cholesterol and Glucose Screening will be conducted on January 28th at 5000 Woodland Avenue, Philadelphia, PA, and February 4th at 1919 Hunting Park Ave also in Philadelphia. Gotta know your numbers and watch your health. Startin' the New Year right.
---NP

What's in a name?

2010-03-13T18:57:00.001-08:00

Habari Ya Asubuhi,.... Kiswahili for 'Good Morning',... and the access name for this blog. So, the other day, my wife Pat, asked me, "Will anyone know what that means?" To which I responded, "Probably not, or maybe a few will, but all will pay attention and ask the same question." So maybe in our discussions with each other the challenge is to stimulate each other to pay attention. The world is changing, and sometimes through paying attention to those aspects of life which may make little or no sense, or that require interpretation, or hmm, maybe some thought?,.. we learn something.... about the changing world, ourselves, where we're going,.. you get the picture. Pretty trite stuff. But important stuff. Do you pay attention to that which all too often doesn't command your attention? So, what is in a name? Habari Ya Asubuhi.

Oh by the way, check out the side panel, Article for the week,... What if Jesus meant all that stuff?