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

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

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

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

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

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?

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

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 :>)