Dar Gracias

On Friday December 19th I once again found myself in Union station, DC watching commuters pass by.  I was waiting for my 12:00 train to Philly where my Dad would pick me up and we would head on to NY.

I had just spent that past week on "vacation."  I left Jarabacoa Friday December 12th and since then had been traveling all over the greater DC area....spending the weekend with PA school friends, then heading up to Delaware for a couple days with my old roommate and finally staying with a dear high school friend in Silver Springs.

And gosh what a sweet time that was.  I haven't spent endless hours with these friends since I moved two and a half years ago.  It was incredibly therapeutic to just sit with them, laugh until tears rolled down our cheeks and share in their jobs, engagements, relationships and lives.  I am so proud of their medical and professional accomplishments.

And as I sat and shared life with them, a huge part of me longed to work beside them as a colleague.  To practice American medicine.  To have weekend barbecues. To see my family often.  To own a house.  Plan a wedding.  Be expecting a baby.  To travel.

Almost three years ago, in missionary training school, they said from now on we would always have a divided heart.  We would have two homes.  A foot here and a foot there.

And for a long time I couldn't relate to that, I didn't feel like I fit in either place.  A year after I left NY it didn't feel familiar.....yet neither did the Dominican.

Now, I can go back and forth fairly easily without major culture shock but complete love and appreciation of both places...the good and the bad.

So in my divided, dichotomous state with love for community health internationally but also American medicine; living cross-culturally but also comfortably in the states; living an adventurous life but wanting to settle; following Christ over seas but also wanting to spread the gospel in the states...where am I left?

During my time at home I have found a new love for our country.  For the professional opportunities, a future family,  the seasons (ok so I've always loved autumn), the American people; but mostly sharing the love of Christ stateside.

Lets be clear...No, it is not time to leave the DR.  

I know I still have much to do.  But how cool to know that God is growing love in my heart for my own culture.  Which can only mean someday he will call me home....

But until then... he has given me awesome opportunities to combine the DR and NY as my Dominican family came to Queens for Christmas this year!  And so on Monday I found myself a tour guide of the subway, Rockefeller Center, Times Square, the Marriot Marquis and Bryant Park.  How surreal not 5 years later after living there to be sharing "my city," in Spanish with people who mean so much to me.  I was so grateful for that gift.

And as I look to 2015, I am still excited to be living in the Dominican...there is SO much more to come in Jarabacoa!!

~Fernando and I have been asked to help a Dominican Physician open a new community health site in Santiago (the city!) with SI.  

~We are looking to open a new clinic in a rural community called Mahaguita...only 276 steps down a mountain side.  

~We will also welcome a new Dominican Assistant to help us (that will make 3!) who like Caroly and Shaki is in medical/dental school.  

~And we have 2 American nurses (Katie and April) and a public health worker (Helena, my previous intern!) coming on staff with us full time.  

Plus...we will continue to welcome students, interns and volunteers to walk beside us as we venture out into our communities and serve both Haitians and Dominicans.

So thank you.  For being interested in my work.  For supporting me.  For praying for me.  But mostly, for caring about the future of my patients and friends in the DR.

I wish you only the absolute merriest and happiest of Christmas and new years.

Love,

Rachel

We've been shut down!

.........ok I'm being just a tad bit dramatic....BUT

This awesome new rural clinic in Limonal has

Replaced our clinic site in Mata Gorda.

AND!!!!  I couldn't be happier!!!

As I head out to my communities I often find myself thinking about what my long term hope would be for my six clinics that are so near and dear to my heart.

Well, in Mata Gorda that hope has turned into a reality.  

Allow me to explain.  Throughout the DR you can find sporadic government funded rural clinics called Poli Clinicas.  They are staffed by residents and attending physicians.  Kind of the governments way of taking care of the poor.  They serve as primary care centers, vaccination hubs and urgent care sites.  They are free to all (even my Haitians!) and also offer medicine.  Many times they are short on medicine due to inadequate funding but for the most part they function quite well.  

Patients in Angosto, Corocito, Mata de Platano, Sabaneta, Buenos Aire or Mata Gorda have never been blessed by one of these medical centers....until now!!

So join me with excitement!  Mata Gorda now has a clinic open to them 24/7 to help provide regular and emergent medical care....run by Dominicans!!!

When Fernando and I decided that this was the solution to this community's health needs we also had to think of the ministry aspect.  I can confidently say that many of the spiritual needs of Mata Gorda are being met by a new social work site started by an SI missionary Yohana and a new church plant by her husband Andres.

I don't think there is anything more beautiful from a community development/missionary stand point than seeing a government trying to meet the needs of the poorest of its people and churches being planted and grown....times they are a changin.  And man would I like to see that happen in all my communities.

But, until then....Fernando, Caroly, Shaki, our students and I will keep seeing patients, sharing the gospel and now looking for a new community to fill in our schedule.

Stay tuned... 

I didn't know they were hungry...

Where do we draw the line between "When Helping Hurts" and Christ's mandate to give all to the poor?

I find myself pondering this question a lot these past few days.  The new shift in missions is towards accountability, to being met halfway by the people we are serving and icks-naying free hand outs.  

For the most part.

I agree with this ideology.  We (people in general) have unintentionally ruined relationships by giving of our own volition creating a hazardous dependency in which once we (the provider) have been removed from a situation the receiver fails to stand on their own two feet.

The new mission model has created a beautiful partnership.  And, as someone who uses this model daily, it works.  My patients have dignity and our relationships have freedom without the weight of dependence.

But.  Then I was confronted with a new situation.

Last week, I went to visit a patient whom I see weekly.  We always arrive at her house in the afternoons, after meal time.  I knew her family was poor.  I knew 6 of them lived in one small room.  I knew her husband hasn't had work for 5 months.  But, I guess I didn't understand how that translated into their day to day living.

This family is hungry. 

They are not eating daily.  And when I ask, they already feel like I've done so much for them, and so they lie.  

This brought to fore front my previous question.  In the New Testament Christ makes it obvious that we are to give to the poor.  Most notably in Luke 12:33 

"Sell your possessions and give to the poor."

But how much?  I could feasibly drop off food every week and help them with gas and electricity....they are used to living on such a low standard of living I'm sure they could survive on $100/month.  And I could probably cut back on my own lifestyle and afford to help them, but would that be healthy?  Probably not on either side.  But they are hungry and are more than just faces to me, they are friends.  And so of course I want to help.  

But how much giving is too much?  Not enough?  Where do we as Christians find that healthy, Christ-mandated balance?

In this circumstance, Fernando and I have begun looking and praying for a job for the husband.  Of course in many circumstances in an impoverished country work is the key to many financial hardships.  But what if that doesn't happen?  In the DR, unemployment rates are high.  Especially for Haitians.  Will dropping off a bag of rice and beans every week damage our friendship?  Or do I let my friends go hungry?

Please join me in praying for this ethical dilemma.  I trust "what would Jesus do" to help guide me....so help me find....what would He do?

Dr. Fernando reviewing anatomy with our medical assistant
Caroly in our clinic in Angosto

Bienvenidos, little one!

I have the most incredible job.

We're still waiting to find out her name!

I wasn't really looking forward to this weekend.  I had no plans except church on Sunday.  Which makes for the fourth weekend in a row without a concrete activity.  Since returning to the DR I have found I crave this chill time...but this weekend I was finally ready to resume my faster pace of living.

And so, I wasn't disappointed when I received a call at 6:30 am from Dr. Fernando at the local clinic that my dear sister/patient/friend Rosne was in labor and therefore we would be performing her c-section unexpectedly early.

So that is how I spent my mañana...

Praying with my dear Rosne as she was prepped for her ceserea.  I held her hand in the OR as the anesthesiologist gave her an epidural.  I cringed as I saw that her blood pressure was high (160/110) despite my more than weekly visits to her house and provision of Methyldopa.  I thanked the Lord that we decided to have her deliver at the private clinic where she would get good care as opposed to the public hospital where my dear friend would be treated as a number and her high blood pressure not as closely monitored.  I heard the cry of her newborn daughter as she was brought into this world.  I watched the expert hands of Fernando perform a tubal ligation and suture her abdomen closed.

And this afternoon...I rejoiced with Rosne as she finally had her baby girl.  And I now have a sweet Haitian god daughter.

Me and my goddaughter :)

So from the bottom of my heart, and Rosne's (she made me to promise to share with you), thank you. For your prayers.  Your concern. And your love.

Caroly (my assistant), Rosne and her baby!

Imperfection?

I passed.  In so many ways I feel as light as a butterfly.  I don't need to worry about medical tests or boards for 10 years.

But through my studying and preparations I saw how ugly my heart can be.  As PAs we have more than one opportunity to take our boards...I think it may be something like five times.  But, due to my incredibly public life, taking my exam didn't just slip under the radar like other PAs.  No I had to apply for a leave from my international job, fly home, study and take the test.  Without any board preparation.

And yet, my greatest concern wasn't that I pass for myself or my patients, but that I wouldn't have to admit to seemingly the entire world that I failed.  My supporters who believe in my skills and my patients who are receptors of my knowledge.

I also realized how much of my identity is in grades and doing well in things.  Ugly.  I was so confronted with this reality that I was almost positive that I would fail so that I needed to admit to the world imperfection.

But then, that is not the God we serve.  We serve a God who honors His call on our lives.  And provides us with the resources needed to do that.  For me, my license.

And so, I thank Him.  For carrying me when I was tired.  For helping information to permeate into my brain and then allowing me to retrieve it when needed.  And for continuing to shape my flaws.  My ugliness.  And any part of my identity that fails to be focused on Him alone.

Once again....I am always learning....

buh bye 20s

I do not want to turn 30.  I am kicking and screaming each day that is leading to September 8.  And yet despite my search for the fountain of youth the days keep coming.

Why am I so resistant?

Anyone who knows me knows how much I usually love birthdays.  Each year growing up, my poor mom had the difficult task of trying to live up to my unrealistic birthday expectations.  I have always thought life deserved to be celebrated, and greatly.

When I moved to the DR at age 27 I thought of how I would be turning 30 during my time abroad and what that would look like.

As I have been incredibly challenged this summer, I have found my thoughts drifting negatively to 30 and to what I am lacking.  Instead of thanking The Lord for the incredible gifts and opportunities I have been given; I have focused on exhaustion, heat & humidity and missing the comforts found in America.

I am ashamed that in my trials; struggles have been whispered into my ears and taken root in my thoughts.  Lies of inadequacy, of the sacrifices of following Christ, of no longer fitting into my home culture, of if I would ever fit into America again, of what good am I really doing in the DR.

My thoughts have focused on the abundance of engagements, weddings and pregnancies that continue to bless my dear friends and yet I continue to serve The Lord solo.

I don't share this for a pity party.  I share this as a reality of the struggles of being tired and on the mission field.

This past month as I have been cramming for my boards, I have had more time alone than in years.  And that is when 30 has even more become this horrifying age of what society tells me I should have but so clearly lack.

I don't have a high paying job.  I don't own a house.  I don't have a husband.  I don't have children.

As my laments became stronger and stronger this month, I had the opportunity to go away for a weekend.  To celebrate my roommate as she moves back to the states.  To be in air conditioning away from the heat.  To eat a variety of vegetarian foods (I was even becoming sick of rice and beans....the tragedy!!!).  To sleep.

And to spend time alone with The Lord.  When am I going to learn that is always what is needed? Always (see missionaries are far from having anything figured out).

When I was living in NYC 5 years ago; I had money, I dated a lot and had a prestigious job.  I was living our societal ideation of success.

But I lacked purpose.  Fulfillment.  Meaning.

I lacked Christ.

During my time alone with Jesus at the beach, he lead me to 2 Corinthians 16-18 which reads:

"Therefore we do not lose heart.  Though outwardly we are wasting away, yet inwardly we are being renewed day by day.  For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.  So we fix our eyes not on what is seen, but on what is unseen.  For what is seen is temporary, but what is unseen is eternal."

As I pondered these verses, I reflected...

I may not have societal successes but...

I have CHRIST!!! In a post-modern world I have a relationship with the creator of the university and He has chosen me to follow HIM!

I have an adventurous life in the DR.  I have an incredible Christian community who sharpens and grows my faith on the regular.  I have countless friends all over the world.  I have the privilege of paving the way in medical missions, teaching nursing students, tackling the tropical disease Chikungunya and sharing the love of Christ.  I am living my passion.  All the time.

So, Rachel, what is 30?  What does it matter the earthly things we are lacking when we as Christians are looking toward our eternity.

I still struggle with turning 30.  I know age may always be difficult as the future continues to close in.

But, I am so grateful to be reminded of the choice to be thankful.  Just like we daily choose to follow Christ, I can also daily choose to look at the incredible path that has been paved for me.  That hopefully glorifies God and forever impacts those I work with.

My life is so full.

What is a number anyways?

Disciple to Multiply

I am like a proud Momma duckling.  Ok, that's a little tacky and extreme.  But nothing is more fulfilling than watching someone you love and have poured yourself into attempt to walk upright in the Lord, take control of her life, achieve yet again straight A's in school and share her passion with others.

In case you didn't know, I speak of Caroly.

Yesterday, we welcomed another graduate of the Women's Volleyball Program into our site.  It is my dream that when my two nurses come on staff they have a Caroly (read clearly, not Caroly, A Caroly....haha).  And yesterday we began that training process.

As we sat in Angosto and I watched Caroly teach Shakira how to assess vital signs, I sat in disbelief.  How far Caroly has come in a year.  She has taken ownership of her life, her future, her passions.  And now she is sharing that with her peers.

Multiply.  We disciple to multiply.

And so, I may be getting a little ahead of myself since we just began day one, but I give thanks.  For the lives of these young girls who are beating the odds, becoming educated and have incredibly bright futures in front of them.  THEY are the future of the DR.

Jeremiah 29:11

Tomorrow begins a new season without teams.  An autumn filled with "normal" clinics as just Fernando, Caroly and I will head out to communities alone for several months.  Then in October we will be joined by three nursing students from Bethel College until Christmas.

This morning I sit rocking on my porch, eating a sweet mango, reading through the gospels and reflecting on the last three months of intense ministry.  Some times I find myself wondering whether reflection is truly a healthy thing.  It is good to learn from our choices but in the same regard it can be oh so painful to see our down falls.

Recently, I wrote an email to a dear friend and mentor and was finally able to identify the sour taste I had in my mouth about this summer.  My plate was so full (all with things I am incredibly passionate about) that I wasn't able to give my best and do an incredible job, in fact, in anything.  I shamefully admit, I just barely got by.

I've shared about the illness we had with students...when at one point I had more than 40 sick participants over a weekend.  I myself was sick with an amoeba.  I have been trying to study for my boards (Sept 11).  My roommate and I led the intern bible study and mentored three more intensely.  I had a two week eye clinic in which we saw more than 600 patients.  And I began a new branch to my ministry working with the shoe shine and street guys in town.  I was the director of a dear friend (and fellow missionary's wedding) and we hosted past interns through all the wedding festivities.  All this while continuing my regular clinics.

I hate feeling like a failure.  But, as the summer wrapped up and I said goodbye to the interns, thought about the 18 participants who served in my site and realized how tired I continue to be, I can't help but pray that God's sovereignty shone through all my inadequacies.

Last summer, my site was new, missionaries in town didn't know I existed, my patient load was low and interns were an added bonus to my ministry.  This summer, my clinics have become so busy I never seem to have quite enough time to pour into the students and patients that I once did.  Let alone adequately disciple interns in the way I felt they deserved.  Thankfully, God is sending me two nurses and hopefully a volunteer in 2015 that will allow us to give both the participants and students the attention they deserve.  Because, I am truly here for both.

This summer I have also found that God has ignited a new passion in my heart through Marcos and has given me the opportunity to work with some of the street boys in town.  It started with one but is growing as Jim (missionary starting a site for the shoe shine boys) and I realize what an incredible conduit medicine can be and how many physical ailments those living on the streets suffer.  In the fall I hope to devote more time to them and will add a clinic day for them to my schedule.

I'm proud to say my site currently serves Dominicans, Haitians, street kids, those with physical and mental disabilities and missionaries in 7 different communities and a special needs school.

And on July 27th I celebrated my two year anniversary of living in country.  Amazing.  Baby steps to get to where I am.  Perhaps reflection isn't awful and maybe God's sovereignty has shown through all my inadequacies after all?  As more participants work with Fernando and I and discover their passions.  As patients are healed through the gospel and physical ailments have become controlled.  And I see past nursing students begin to make their mark on this world.

The front of my journal is inscribed with the famous words God spoke to the prophet Jeremiah.

"For I know the plans I have for you," declares the Lord, "Plans to prosper and not to harm you, plans to give you hope and a future."  Jeremiah 29:11

Yes, I can say in the short term (the past 3 months) I don't feel as if I was as successful as I hoped.  But thank the Lord success in heaven is not the same as our human standards.

And so, perhaps instead of thinking of how stretched I felt this summer, I will think of the doors God has opened over the past two years and the way that hopefully His glory has shown through all of my shortcomings.

And I will embrace the newness of autumn and the fresh opportunities it will bring.

Amoebas, Pink Pandemic and Chikun-what??

Well, to call this the summer of illness would be an understatement.  Ready for some medical talk?  Haha, I am a medical missionary...

As I shared before, I ended June with an amoeba.  Then around the same time Chikungunya hit the island…which has become a bit of an epidemic.

Chikungunya is a mosquito born illness that creates intense and uncontrollable joint pain, high fevers, headaches, body aches and occasional GI distress.  This virus has ravaged our island and quickly depleted our supplies of acetaminophen (Tylenol).  

I have been spared at this point but each community I visit seem to have more and more patients contracting the illness along with several of our missionaries.  It typically lasts about a week with residual fatigue.  Those at highest danger are the young, old, pregnant and immuno-compromised (as with most diseases).

This week we welcomed our second to last team for the summer…it’s hard to believe we’ve been going straight since May!  And with them my long awaited optometrist.  At this point we have already fitted about 180 people for glasses.  What a blessing!

On Thursday things got a little complicated when at 2am I received a call that students were having severe diarrhea and vomiting.  By Friday afternoon 37 of 75 people living at our base had contracted a viral GI illness with fever, diarrhea, vomiting, nausea and back pain.

I knew my hands were full when they literally could not keep any medicine I fired at them down…including orally disintegrating Zofran!

As Fernando (my doc) also was sick this past week and unable to assist me, I was so grateful for the past couple of weeks of rest.  Early July began an intense period of time when I began to understand self preservation, and so I was ready for what we’ve deemed the “Pink Pandemic (ok…it’s not quite a pandemic or pink but pepto bismol has just been a necessity).” I put together my task force of interns and together we tackled vital signs and evaluating each patient to ensure they hadn't become dehydrated.

This morning, I once again marveled at God’s timing when I stayed healthy through the night and was good enough to evaluate patients this morning.  I am so grateful that this virus lasts only about 24 hours.  Not just for my patients, but because once most of them were in the clear I realized I am not immune and have found myself also developing symptoms.

And so, I ask you to pray with all of us.  It’s hard to understand why so many students would be incapacitated when they are here to serve, but it just continues to remind us of the weakness and frailty of our human bodies.

I am praying for strength, recovery and no further spread of Chikungunya or this gastrointestinal bug.  Please join me!  I have big plans for this next week of eye clinics!

Gracias!

Common Threads

Do you ever find yourself encompassed in themes?  Not fairy tale or drama themes, but perhaps lessons that seem to envelope your life, over and over and over again?

Three weeks ago I hit a painful wall.  After almost two years of being a medical missionary with summer in full swing; my community clinics thriving as well as personal patients I became numb from exhaustion.  Sometimes this seemingly relaxed culture in which I dwell can play tricks on my mind and make me feel like I am getting enough rest or time off from being the "on-call" doc when in reality I'm not.

Ok, so that made me step back and talk with some wise people in my life about how I can draw some boundaries (gosh I hate that word).

And find some silence.  And spend more time with the Lord.

Then our next team arrived.  And life was busy again, but in a good way.  Once again I was finding it difficult to have time for myself, but that's ok, I love what I do!

On Sunday at church our Pastor preached on the importance of resting in the presence of the Lord and how easy it is to become so busy serving Him that we don't have time for Him.

That same day I began reading the bible study my roommate Chelsie and I will be leading our interns in this week....on the spiritual disciplines of Silence and Solitude.

And just to re-enforce the wake up call I needed for rest and rejuvenation in the presence of the Lord...this week I have been completely disabled with a gastrointestinal amoeba.  Yuck.  With a 103 fever and 6 lb weightless in 2 days, I have had no choice but to be humbled and spend time curled up in the fetal position in silence, solitude and the presence of the Lord.  Por fin.

Don't worry.  I'm on the mend and tomorrow I'm planning on going back to work.  I have been more than appreciative of the way people have served me in my time of illness :)

But, clearly the Lord wants my attention and is trying teach me what I need.

How often we ignore those early signs or messages He is sending us.  He always knows what is best for us, yet why do we let the busyness of life get in the way?  Even if that busyness is serving Him?

"The Lord YOUR God is with you

He is mighty to save

He will take great delight in you

He will quiet you with His love

He will rejoice over you with singing."

Zephaniah 3:17

So, my challenge for this summer is to find rest in His presence amidst teams, patients, studying for my boards and mentoring interns.  To find quietness amidst the chaos.   Because it's there, and I know so is He.

Summer is Here!

DoRe Interns 2014

We are officially a month into teams....I have welcomed 7 students into the community health site on a one week and then a two week outreach.

One of the biggest blessings of the summer are the 12 interns who work within each of our sites.  My roommate Chelsie and I have the opportunity to lead the intern bible study on spiritual disciplines and get to know them on a more intimate level. 

Kacie Johnson (front row, fourth from the left) is my medical intern!  She is a fourth year nursing student who has spent the last three summers serving at the Christian camp Hume Lake in California.  She has a passion for students and children with disabilities.  After serving together for several weeks, I know we're in for an awesome summer of ministry together!

Please keep us in your prayers as we continue to welcome groups, take care of patients and prepare for an "eye" outreach in July complete with an ophthalmologist!

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Please also keep "Miguel" in your prayers.  We had a valuable meeting with a psychiatrist and infectious disease doctor last week in La Vega.  We're hoping "Miguel" will make his next visit on his own.  A huge answer to prayers came when "Miguel" was able to find a job.  Jim and I will continue to work with him on a weekly basis and set life goals.  Next step- finding housing. 

My biggest prayer for "Miguel" as he starts treatment is that he will remain compliant.  He is currently feeling great and asymptomatic, this will probably change as he continues with treatment as we don't have accessibility to the better tolerated HIV meds found in the states.  But, I continue to believe in miracles and that "Miguel's" heart changed for Christ will allow him to prevail.

I hope all of you stateside are enjoying warmer weather. :)

"Miguel"

Is this really mi vida????  I found myself thinking today as I pulled up to an abandoned, halfway built concrete house with a fellow missionary (Jim) at 7am and we headed down the mountain with my newest Haitian patient to an HIV specialist.

"Miguel" is homeless, has a past history of drug abuse and theft.  He has been in and out of prison multiple times and has been known to deceive and con those closest to him.  And, he's 19.  Only.

Being Haitian alone places "Miguel" at risk; but a known law offender does not help his cause.  Despite being placed in difficult situations with "Miguel" over the past year Jim has not given up on his life and has continued to encourage, love, mentor and guide him.

And finally, after a traumatic jail experience in February, "Miguel" opened his heart to the Lord.

He left prison a changed man.  

If only his exterior matched his new heart as there are many people in Jarabacoa (including fellow church members and police men) that need to be proven otherwise.

So why would a PA be thrown into the mix?

When "Miguel" was discharged from prison he found out that he is HIV positive.  And when he found this out...so did everyone around him.  Leaving "Miguel" without a job, a home or friends.  On top of this, his Mom died of heart disease in Haiti leaving him an orphan.

All this after he accepted Christ as his savior.

Welcome to our challenge of walking with a new believer and helping him to see the blessings of God amidst the repercussions he is suffering, as he walks through depression and suicidal ideation and attempts.

I have spent the last month meeting with Jim and "Miguel" on a regular basis and in the mean time trying my best to find him help.  Free HIV treatment exists in this country but how do I find information when I live in a remote mountain community without resources and things are just not organized and well advertised?

As I was pondering this question last week at my clinic in Corocito in walks a patient with well controlled HIV. Thank you Lord.  I cautiously breeched patient confidentiality (which doesn't exist) and found her incredibly willing to help "Miguel", including going with him to La Vega if needed.

Meanwhile time is ticking and "Miguel" is wandering the streets without food, family or even soap to bathe.  It would be so easy for him to slip into old ways to get money...stealing or robbing.  Yet he has restrained.  He is changed.

We made our first journey to the free public hospital in La Vega at the bottom of the mountain Tuesday afternoon and were disappointed to find that the HIV clinic is only open in the morning.  But thats ok, I think Jim and I both prepared ourselves for "un proceso."

Today we made the journey again.  And amidst the confusion and lack of organization, God provided an angel in the form of a happy Dominican woman with tinted red hair who has worked at the hospital for twenty years and took mercy on her two rubios and an Americano (if you can figure out which each of us is, I'd be greatly obliged!).

With Rosa's help we were given all the papers needed, taken to 4 different offices, quickly saw a referring doctor and were given an appointment with a specialist and for blood work next Friday.  All this before 10 am.  Gracias a Dios.

Jim and I found ourselves sitting with "Miguel" after returning to Jarabacoa in my office thanking the Lord.  For direction.  For help.  For an appointment.  For hope.  But mostly for "Miguel's" continued growth.

We than made an accountability plan.  If we are going to help "Miguel" with his medications and transportation he needs to meet us half way.  And so, today "Miguel's" life plan began.  We need to see church attendance.  Better hygiene.  Efforts to find a job.  It's time to live for a real life filled with a future and not just walking the line between life and death.

So join me.  Let's pray for "Miguel."  Pray that he won't stray from the Lord in his vulnerable state but continue to see the life he can have with Christ.  Pray that we can control his HIV.  That he can find a job and a house and his friends will no longer see him as a leper.  I want to see the change in him that I have had the opportunity to see in so many others; physically and spiritually.

I believe in a God who can work miracles.  Do you?

On Monday I received the call that Milagros was finally home from the hospital in Santo Domingo...2 weeks post-surgery.  The next day Mary Ellen (missionary in charge of hospitality at the base and Milagros's supervisor) and I loaded into my car and headed to her house.

I was surprised by how close Milagros lives; only a short drive up a dirt road behind the base....but it truly felt like a different world far more similar to the remote communities I visit in the mountains (like Angosto or Mata De Platano).

I am around poverty all the time.  My favorite patients live in scrap wood houses with cockroaches, lizards and rats scurrying in and out.  So, I was shocked at my internal reaction to her living conditions.

Milagros lives in a tiny house the size of an American living room partitioned into three spaces for a kitchen and two bedrooms.  The walls are made of moldy wood and plywood, the floors are hardened dirt and most of the time she has no electricity or running water.  A small outhouse is positioned behind her casa.

When Mary Ellen and I stepped out from my car; no bigger smile could have been seen. It was a little crooked with a large suture line at the posterior aspect of Milagros's cheek and tears flowing from her eyes as her tear ducts were affected by the surgery.  But nonetheless her cheeks were symmetrical...at last!!!  And that smile was so full of joy.  Her surgery was a success! Praise Jesus!

We sat with her in broken plastic chairs outside of her house amidst plantain trees and listened to her experience.  Milagros has been a very challenging patient since the beginning but The Lord has filled my heart with such overwhelming love for her.

Milagros stayed with her half brother in the capital.  He is quite poor and everyday looks for enough work to live.  Because of his quest for survival, Milagros was alone the day of surgery, while in the overcrowded hospital and while taking a taxi back to his house several days later.  Not one person visited her.

And now, here she is in her own small, hot house recuperating yet again alone.  She is not married, her two children work and the rest of her family are unsupportive.  How very different her experience looks than when most of us have surgery in a comfortable hospital with attentive nurses, supportive family and friends who cook and clean and transport us and then a comfortable house and bed to recuperate in.

Milagros fought for her surgery and she won.  She is doing great and she was able to get enough governmental assistance to afford her surgery.  But, the injustices of poverty in her situation are so overwhelming to me.  Does she not deserve the same as me?  Or you?  What is the difference in who we are? Our birth place? 

I am so thankful for all of your prayers for Milagros.  May you continue to pray for her healing and her next surgery as she also requires a full hysterectomy due to uterine fibroids that we're hoping will take place in August.

While I'm grateful for this small success, as I continue to be surrounded by innumerable injustices my quest for good health care, community development and that everyone may know the love and hope of Christ continues.  And don't you worry, I will be regularly visiting Milagros.

Pureza Retiro

This week I was blessed to have the opportunity to serve in a different capacity than normal.  Jess and Chelsie (leaders of Students International's women's sports site), Raul Canela (leader of our men's sport's site), Heidy (leader of our Los Higos social work site) and Jerry Cabot (youth pastor at my church) combined forces to put together a 3 day purity retreat for 60 Dominican Youth.  And so from Monday-Wednesday of this week, our base was filled with the laughter, joy and tears of youth from our communities.

Don't get me wrong, I love when we have American teens scampering around our grounds....but there was something so special about having the base filled with Dominicans.

The retreat focused on teaching the importance and value of marriage and glorifying the Lord with our minds, hearts and bodies.  The leaders got down and dirty as they tackled difficult questions and many of the youth had to confront broken images of family as marriage is not widely valued with many Dominicans.

Games were played, seminars were taught, testimonies were shared and  lastly the weekend terminated with a marriage ceremony in which we went through a mock wedding and the youth had the opportunity to "casate conmigo" or make intimate declarations of purity in front of their leaders, community and the Lord.

It was so much fun to be running behind the scenes and filling in the gaps and encouraging each participant as they took charge of such an important area of their lives that is so often overlooked in all societies.

Each girl was given a rose

The chapel at the base was all ready for a wedding!

The students signed a declaration with
various commitments

to be married with Christ :)

Raul prepping the guys for the importance of this decision

The girls all dressed up walking down the aisle

Each guy gave a girl a rose and escorted her to her seat

Waiting to walk down the aisle.  Yup that's Caroly my assistant
in the white!  She was a leader on the retreat.

Wedding Cupcakes!

60!

Heidy, Jess and Chelsie praying with each girl that
committed herself

The purity retreat was a great way to start Holy Week.  It was an amazing time to reflect the importance of giving up all of ourselves to the one who gave it all for us.

I hope and pray you have a wonderful Easter weekend and are reminded of the huge sacrifice made for all.  

Update: Milagros had her surgery (parotid gland tumor removal) in Santo Domingo yesterday.  I haven't heard how it went, but please continue to join me in praying for a safe and healthy recovery.

Patient Up Dates and Prayer Requests

I am so grateful for the prayers you send my way as I care for each and every patient.  Below is an update and further requests for four very special people that are near and dear to my heart.

Julian Hock

Julian is doing wonderfully.  He is a vibrant four year old with lots of energy, smiles and hugs.  If you remember, his mom Catalina was my Spanish teacher and is now on staff with Students International running our social work site in Los Higos.  Julian had a fractured left tibia which caused him an extreme medial deviation of that leg.  I am so excited to say that his deformity is almost completely healed after a rod was placed by missionary doctors in Santo Domingo in August 2012...only one month after my arrival to the DR!  He has a follow-up appointment in July at which point the orthopedist will determine when the rod needs to be taken out.  Please continue to pray for his healing.

Roseny

Roseny is my dear Haitian friend.  I met her over a year ago at the Haitian church I occasionally attend.  She speaks fairly decent Spanish and moved to Jarabacoa 12 years ago from Haiti to look for a better life.  She is a devout Christian and is continuously offering what little she has to her neighbors.  She volunteers her time on Wednesdays with me to translate for Haitians that do not speak Spanish, what an incredible blessing she is for me.  Roseny has 3 adorable sons and recently discovered she is yet again pregnant.  This is worrisome as she had pre-ecclampsia with her last child and has had uncontrolled Hypertension since.  She has seen a cardiologist and we are keeping a close watch on her...but she still has 7 months until her due date.  Please keep my friend close to your prayers and heart!

Milagros

We continue to pray for a miracle with Milagros as her surgery date is quickly approaching.  She continues to miss a lot of work and struggle with compliance, but we pray her diabetes and blood pressure will be controlled enough for her parotidectomy scheduled on April 14th.  Please continue to pray for her understanding and healing!

Juana

Juana's family has become my Dominican family.  She is standing next to her husband in the pink.  She has graciously opened her home to me and my students for multiple dinners.  Last year she was diagnosed with Stage 3 fatty liver disease...the stage before transplant.  This past week she has suffered a flare and was hospitalized.  We only have one gastroenterologist who comes to town once a week...I will be attending her meeting with him today.  Please pray that we are able to control the pain, bloating and fluid production that she is suffering and that she isn't progressing.


Thank you for being a part of my work in the Dominican.  Please let me know how I may better pray for each of you!

jOy!!

Today was an incredible day...not only did Rend Collective (my favorite Christian band) release their third album....

BUT

I met with Milagros and her meeting with the maxo-facial surgeon last week couldn't have gone better.  She brought her blood pressure and blood sugar records from our meetings and he APPROVED her for surgery!!

I attribute her new-found initiative and understanding to your prayers.  So thank you thank you for remembering her!!  If you could continue lifting her up; surgery is scheduled for April 14th.  :)

Milagros and I; you can see the 30mm Parotid gland
tumor on her left cheek

Also, pray for Milagros's continued depression.  I was ecstatic by the surgeon's approval, she however remains skeptical after so many failed surgical attempts previously; understandably so.  I will of course keep you updated!

Milagros, Keep Praying!

"Let them give thanks to the Lord for His unfailing love, and His wonderful deeds for mankind."

Psalm 107:15

Thursday as I was loading my car and getting ready to head out to Mata Gorda, I ran into Milagros.  She's back from the capitol, at last!

I must say, my initial reaction was frustration.  Here was this woman who only two months ago was crying out for help, desperately alone and needing her Christian family to surround her; yet when we did it appeared she didn't listen.  Milagros did what she felt best, regardless of the advice of those who know better.  Even when we firmly told her that it would be a waste of time and money to travel to Santo Domingo before her Hypertension and Diabetes were controlled, she went.

And then, in my frustration I started thinking and remembering the missionary training I endured two years ago at MTI and the chapter on "openness" I just finished reading from the book Cross-Cultural Servanthood and a conversation Sissy (the director's wife) and I recently had.  

I am serving in a pleasing culture.  A culture who at times will place themselves in a compromising position to honor relationships and to prevent hurt feelings.

Yes, Milagros took my advice.  And Betsy (the PT).  But, she also is taking the advice of her endocrinologist, cardiologist, gynecologist and facial-maxillary surgeon.  The last thing culturally she would want to do is let any of us down or un-fulfill her commitments.

Taking the advice of a multi-disciplinary team to an American sounds like an intelligent decision.  But, in a place where there is no correspondence between these providers (no progress notes, dictations, phone calls between specialists let alone electronic medical records) this can prove disorderly and detrimental to a patient.  Clearly, conversations need to be had to come together and decide a logical course of action for a case as complicated as Milagros.

And so, with all this in mind we decided to meet on Friday morning.  To say I went into that meeting a bit apprehensive is an understatement.  Milagros had gone to the capital to try and have two surgeries with completely uncontrolled blood pressure and blood sugar, no doctor in their right minds would operate.  She spent what little money she had and once again she missed work.  And, I had only spent three weeks with her which in my experience is not long enough to control her co-morbidities.

Imagine my surprise when I reviewed her medicine and I realized she was taking everything as I had prescribed.  When I asked about her symptoms (headaches, dizziness, pain) she said she felt the best she has in years.  And, when I checked her blood pressure....it was 130/80.  Completely suitable for surgery.

WOW!  Against all odds, Milagros is getting better.

Milagros was doing and listening and learning.  

And for that I thank you and our Lord and Saviour.  Because, trust me when I say this is a miracle.  A feat I was thinking impossible.

So, thank you for lifting her up in prayers and loving her from afar.  And don't stop!

Please, continue to pray for our relationship to grow, with trust and confidence.  That I may continue to be open to any cultural differences.  Pray for tomorrow when I check a fasting glucose and re-check her blood pressure that I can give her surgical clearance.  

And, most importantly, please pray that despite lack of communication between providers, that Milagros's appointment with her facial-maxillary surgeon on Wednesday will be fruitful.  I continue to hope for Milagros's life to be a miracle.  Join me in this petition.

February.

Do you ever have those mornings in which you are just so grateful to be alive?  I spent this morning with overwhelming gratitude for the little things.  For iced coffee, the roosters crowing outside my window, for the feeling of a warm shower, for speaking to a friend through Skype.

In this week of reflection after the tragic death of a staff member, I have found myself as we so often do in times such as these, thanking the Lord for the breathe of life.  That He would even give us the opportunity to live amongst His creation.  This gift that so often we overlook because it's all we have ever known.  But, how precious it is.  Every part of it.

Life continues to flow in the DR.  I have found this to feel more than ever like home as we as a staff and a community have been involved in all aspects of a full life....with an unfortunate funeral, the planning of a wedding, the welcoming of new staff.  All very different facets of life, yet very much a part of life here on Earth.

We are in a season of preparation.  In two weeks we will have a month of teams.  A time when once again our base will be alive with youth and energy.

I just returned from a week of service in Las Terrenas with Sowers of the Kingdom.  The very organization started by faithful christians from my church in NY that brought me to the DR five years ago.  It was a joy to serve alongside brothers and sisters in Christ from NY and spend time in another part of this country which has captured my heart (about 3 hours east of Jarabacoa).

I continued to meet with Milagros for regular blood pressure and blood sugar checks until last week when she went to the capitol to stay with extended family.  This was her original plan before we started meeting; to have a parotidectomy in February when we as an organization do not have teams and she could have vacation time.  This plan was made before she understood that no matter how much she wanted surgery now, until her co-morbidities were controlled no surgeon would operate.

Last week, without my knowledge, she moved to the capitol temporarily to follow-through with her plan and stay with extended family.  My initial thoughts were dismay.  Who would operate on her?  And once again she would be spending so much money only to be told that she would need to wait.  And after all the hours of education, monitoring, exercising with Sissy and Betsy; Milagros is doing what she thinks is best and not listening to what those around her are saying.

But, this week I have found peace.  Most likely she won't be able to have surgery at this moment.  But, perhaps spending time with family in Santo Domingo will give her the support she needs.  Maybe regularly meeting with her various specialists, will help her finally understand what we have all been trying to teach her.  So, please join me in continuing to pray that Milagros will have the healing she needs...emotionally, physically and spiritually.

This afternoon I am reminded by how vast my role as a missionary truly is.  My roommates and I will be taking 15 youth (some from our volleyball site, others that we mentor) to see my friend Nestor Ortega in concert in a town at the bottom of the mountain (La Vega).  Nestor is a Christian rapper who is becoming very well known, especially abroad in the states and Spain.  I met him when serving with Sowers of the Kingdom several years ago.  I love when various aspects of ministry collide.  We serve a great God, don't we?

I hope and pray all is going well with each and everyone of you and that the brief reprieve of cold weather this weekend rejuvenated your spirit and you can join me in appreciating the world and life that has been created for each of us.  And please, if I may so ask, keep our grieving staff in your prayers as we remember the life of one of our own.

Some highlights from this past month:

Las Terrenas

In Las Terrenas, with Bileysi, my sponsor child

Tita, Dr. Fernando, Oscarina, Michael and Dra. Vanesa
French bakery in Las Terrenas

Cow Jam!

Las Terrenas, taking a break from clinic for lunch!

The beauty of this place.

My new favorite fruit....that I may never have again,
because I can't remember the name!

Samana

Sissy and I!
We had the privilege of going whale watching!

Clinics

My favorite Haitian patient from Buenos Aire

Valentine's Day Party 

Silvia, Mary Emily, Amy, Marcela
We had a missionary kids Valentine's Day Party!

Chelsie (my roommate), Marcy,
Nigera (the daughter of our Ama de Casa)

Nigera, David, Amy, Marcela, Vanesa and Silvia
Watching the Little Rascals

Teams

Fernando and I with our two week group in January