"Don't leave Momma"

We had to stop the car.  She had to say goodbye one more time.

Tears streamed down her brown, dirty face with outstretched arms grasping for one final embrace to the woman who fed, clothed and raised her.  Behind stood her 2 story wooden house, barely able to support itself with dirt floors and bed sheets for walls.

"Don't leave Momma!" We could hear her cry in Creole.

As we pulled away, her mother collapsed into the arms of my friend Rosne, exhausted from being taken out of her bed; red-hot with a fever of 106, respiration rate of 40, blood pressure of 80/50 and a heart rate of 150.  Even to the non-medical provider our patient's situation seemed emergent.

Rosne calmly explained to us that this 4 year old girl had just lossed her 2 year old brother in December to an unknown illness and the last time she saw him, he was being taken to the hospital just as we were doing with her mother.

Dr. Fernando and I sat solemnly in the front seat of my car, knowing how grave the situation was but that we had to try our very best.

Our 32 year old patient didn't just leave this four year old girl, but another small daughter and a one month old son born prematurely in January.  And her husband.  A hard working, yet abusive man who didn't provide much support for our patient or her children.

Our patient's eyes were sunken in and her hip bones stuck out, the closest to a person suffering from starvation that I've ever seen.  She could barely speak as her mouth was so dry from dehydration.

We knew it would be difficult to get her the help she needed, Haitian's are not usually given preferential treatment in the DR.  Let alone this woman.  Who only a week earlier had left the public hospital against medical advice convinced her ailments were caused by demons and an exorcism was the only remedy.

I prayed our entire drive to the hospital which seemed to take forever as our patient's moans got louder and I tried my best to avoid every pot hole in the dirt streets that act as our primary mode of transportation.  I glanced into my rear view mirror and saw my visiting students wide eyed as they experienced medicine in a new and frightening way.

When we got to the hospital I was immediately thankful that I work with a Dominican Physician who loves the Lord and our patients as much as I do.  He managed to get her in quickly and conference with the ER doctors immediately.

The following 10 days were filled with challenges and unknowns.  She was transferred to the closest big city twice, given multiple blood transfusions as her profound anemia continued to worsen and treated with multiple antibiotics.

But, on Thursday February 5th her body gave up and she left this Earth.  Just like that.

This past week we visited the family of our patient and prayed with them.  There is talk of sending the kids to La Vega to live with their aunt.  Hopefully she can provide for three more mouths, especially a nursing infant.

My heart is so heavy.

I know we serve a God that gives and takes away.  But the taking away for those left behind is so hard.  Three children are now left without a mother.  How much hardship can one family bare in such a short period of time?

So please, keep this family in your prayers.

That through all this pain Christ may be known and glorified.  Our patient accepted Jesus into her life several months ago at Pastor NoJean's Haitian church so we rejoice that now she is in a place surrounded by only joy and eternal nourishment.

We will continue to make regular visits to this family and walk beside them.  Please join us in embracing them.

We're Back!!

I am so pumped.

If I had known 2 years ago all the avenues God would open within our Community Health Site, I just would not have believed it.

Fernando and I have spent this week preparing for this year.  And as I have previously shared, it will be an eventful one.  Especially this next month!

Next week, we welcome Helena Duran (our previous intern and volunteer) and April Ether (a previous student) to our site.  That means our medical site literally doubles.  Fernando keeps insisting we are going to be more like a medical gang than anything else.  Watch out communities.  Ha.

Helena and I, during her
volunteer year

Helena just graduated from Boston University with a degree in Public Health!  She will spend 9 months as a long term volunteer with us.  Finally we will have someone who can focus on identifying and preventing community health problems!  We can't wait to see how God uses her fluency in Spanish, strong faith, love of Dominicans and education to impact our communities.

April when she came on an outreach
as a student in March 2012

April is a nurse from Michigan who will spend two months with us as a volunteer and then move to Jarabacoa as staff full time in January 2016!  We cannot wait to have a nurse with us that can increase patient relationships, do house visits, teaching sessions and preventative care.  We know God will use her passion for the Lord and His people to further His kingdom.

As we increase in size, it only seems natural that we should also increase our clinics.  And so, shortly I will leave for a meeting with a pastor in a new community, La Hoya.  And, next week we will have another meeting with a pastor in Majaguita (yes, the 276 steps down the side of a mountain community).

TWO NEW COMMUNITIES!!!

So please, join with me in prayer.  Prayers for Helena and April as Jarabacoa becomes their temporary home and they are trying to use the skills God has given them to help others.  Prayers for La Hoya and Majaguita.  That we may serve them well and develop deep relationships as we have been so blessed to do in other communities.

2015....here we come!!

Praying with patients in Mata Gorda

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....