Know I am God

"Be still and know I am God.." Psalm 46:10

My brother Jamie and I

This was the bible verse given to us at our staff retreat one month ago.  A verse very well known to many of us.  A verse I'm fairly certain I've written about in the past.

Yesterday, at our staff meeting, Brian (our director) asked if any of us have stories of how God provided a time of rest for us since our retreat.  A time in which we were able to be quiet and still.

It was then that the significance of the past week dawned on me.  I returned to the States for a 5 day conference in Washington D.C. followed by a four day visit to NY.  And when I was there I realized that I was tired.

I don't think I knew how exhausted I truly was until I re-opened my site today.  As I sat with patients in Coracito this morning and then welcomed our second team of students this summer in the afternoon, I felt more energized than I have in months.

God knew exactly what I needed.

He knew I needed to be in D.C. at a medical conference surrounded by other PAs and Docs.

He knew I needed time with my previous roommate.

He knew I needed time with my PA friends.

And I needed time with my dear friend's new baby.  Oliver.

And say goodbye to a big part of our family.  Maggie, our dog of 14 years.

 

And spend time with Grandma, aunts and cousins.

And even get out on the boat.  Something I was sure I couldn't do while living in the DR since summer trips home were not in the plans.

I didn't know.  But He did.  

For a week I needed to be Rachel, plain and simple.  Not doctora.  Not missionary.  Not speaking Spanish.  Not taking care of Americans, Dominicans or Haitians.  But just Rachel.  The friend, daughter and sister.

And now I am ready.  I am rested and rejuvenated and energized.  I am excited to pour into my patients.  I can't wait to continue working with Helena.  I'm pumped to welcome new students into my site and feed into their lives.  I can't wait for Caroly to begin!

And so, as I bask in my renewal, I pray each of you may also find your time to be still.

Please pray for Students International as we have more than 70 students staying at the base on two week rotations until August!

Meet Helena

I. Am. sOoOoO EXCITED!!!

Helena Van Troy-Duran has arrived!!  

Helena has just completed her junior year in college at Boston University.  She is a pre-med psychology major, public health minor and will be applying to medical school next year.

We met last summer at which time she had been interning with Dr. Fernando Gonzalez at the medical site with Students International.  Our paths only crossed for one week, but I knew without a doubt that I wanted her to be my first long term volunteer.

I have found very few young women I respect as much as Helena.  She has spent her Christian life continuously stepping out in faith.  

Just last year, she and a few of her friends moved into a college neighborhood known for partying.  While other college students were finding refuge in empty cups of beer and drinking games, Helena was taking part in relationship building and showing a fun, trendy life style that found fulfillment in the true source-Christ.

Oh...and did I mention Helena can speak awesome Spanish?!

So, now you can see why I'm so pumped!  Helena is the incredible gift God has given me to work alongside this summer!  I can't wait for teams to get here (Mon May 19!) and begin ministry with our American students and Dominicans for the next three months!

Please pray for us as we expect 3-4 students to be rotating through our site every 2 weeks until August.  Pray for guidance as to the best way we may speak into the lives of each of our students, many of whom are high school age.  And for continual relationship building in our communities- which now number 5 each week!

Progress and Tragedy

Last Thursday, I spent the morning in Mata Gorda.  Yvenor, my Haitian translator, and I were unloading my Jeep when in strolled two Haitian women.

I took their blood pressures.

One read 180/110...the other 160/100.  And I had tears in my eyes.

If I were in the states, I would be horrified.  I would have sent these women to the hospital concerned that any minute they would stroke out.

But, not here.  Why?  Because they could never pay for a hospital visit.  Because they wouldn't be treated right if they did go to the hospital.  And because they could never afford the medicine they would be given.  Because, they are Haitian, they are poor and they are oppressed.

But, in this moment, in this place, I rejoiced and hugged them.  Just two weeks ago their blood pressures read 220/120 and 180/110.  They have been taking their medicine. 

You see, with blood pressure you can never decrease it suddenly.  It's a gradual and tenuous process, one that is difficult for patients to understand as a health care provider is constantly tweaking a dosage or adding additional medication.  This requires close monitoring even in a controlled environment such as found in the states.

So my patient's blood pressure actually decreasing is a big deal.  They are understanding the process.  They are taking their medicine even when it's confusing with dosage changes every week.  Progress is a beautiful thing.

On our way back into town Yvenor and I received a phone call from Pastor NoJean, a well respected Haitian pastor in one of the communities we visit (Buenos Aires).  The night before, a scrap wood building that housed 10 families with 10 infants and children, 7 single men and 4 single female burned to the ground.  And many of these are our patients.

How devastating.  How difficult to understand.

And so we went.  And we shared in their grief and sadness.  Each of them had rented a small 5x8 ft room and now what little they had was gone.

When we were there, God reminded me of the deep relationships we've formed over the past 4 months.  We collected supplies and toiletries and food.  We prayed and we comforted.

But the dichotomy of that day, with progress and rejoicing in the morning followed by sadness in the afternoon wasn't lost on me.  Even with advancements we are reminded of how fallen this world is.  That regardless of how much we move forward there are still uncontrollable circumstances that continue to render things hopeless.

As Yvenor and Pastor NoJean and I prayed with this community Christ filled me with words that were not my own.  With reassurance of His sadness and tears that fall with ours.  That regardless of materialistic circumstances we are not to bury our treasures on Earth.

And so I was reminded of how important our work truly is.  It's not just about health care and community development.  It's about love and discipleship and holding a hand when the un-thinkable happens.  And so we will continue sharing the gospel, so when un-foreseen tragic circumstances occur in this broken world we can all be reassured of where our home truly lies.

Please join me in praying for the community of Saboneta as they are dealing with lossed possessions, post-traumatic stress and tragedy.

Hilary Guest Post

 Good morning blog-o-sphere.  Below is a guest post from Hilary Holbrook.  Please look at my previous posts to hear more about her and her ministry in Mexico!

"This has taken a long time for me to write...not because I didn't want to, but rather because I needed to sort through everything going in my head. Everything I saw, experienced and got to be a part of for the past week and a half is more than I can put into words. But I promised Rachel I'd try! Rachel apologized quite a few times that we wouldn't be able to go to the beach and relax. My response was always the same - first of all, I live in San Diego. The entire city is on the beach. Second of all, I'm not here for vacation! I want to live your life with you. 

And that is what I did! Rachel has an office near downtown Jarabacoa that is beautiful - she shares it with a dentist who also works for Students International. She's there Monday and Friday to see patients. Tuesday through Thursday, though, are the days that Rachel lives out her calling. This is where her heart is. As I helped her load up the back of her car with boxes of medicines and bags of supplies, I watched her light up. We took off, picking up Yvenor, her Creole translator (but soooo much more than that - this guy is amazing) and set out. Tuesdays she spends the morning in Coracito. The road was terrible - much like what I've seen in Mexico - not paved and really bumpy. We pulled up to a cinder block building that literally had four walls and a roof - nothing more. I thought for sure this was not where her clinic would be. She saw my reaction and laughed, telling me to get out because we had arrived! Inside was nothing more than a table (just one) and about 4 plastic stools. There was already a line of about ten people waiting for her.We saw lots of patients that morning – many who had high blood pressure, lots of people with colds, a 2 month old, a teenager and older man who Rachel gave glasses to (we watched them light up as they saw for the first time in a long time)… 

Angosto was a very poor community that was really far from downtown, making it difficult for people there to get healthcare. If they even had a moto (which most of them didn't), it was probably about a 30 minute drive on absolutely terribly roads. Ironically, this is her nicest site - in the library of a beautiful school. Again, people were waiting and we had to turn patients away. One of the most cumbersome items we packed and unpacked over and over was her box of patient charts. It took me a couple of days to realize the significance of this box that already had well over 100 charts in it. Since Rachel started her clinics in January, she's seen all of these people. And the part that was so incredible for me to see was they’re coming back. People who haven't been to a doctor in as long as they can remember, people who have dangerously high blood pressure and haven't been able to do anything about it, children who have strep throat...these people know about doctora Rachel and she has become their primary care physician. My job for a few days was to take patient histories on her new patients. There were quite a few times when I went to start a new chart and the person said no, I already have one. I've been here before. 

I don't know if I'll be able to accurately explain this, but that is so huge. In less than 4 months, Rachel has used her God given gifts to create something incredible where there was nothing. She didn't step into this position after someone else left. She started this. All of this. She's created an environment of trust, respect, and incredible dignity for her patients. She's constantly thinking of ways to make things better and more professional in what most people would consider a very unprofessional environment (see my description of Coracito!), even going so far as to sew a curtain to hang up at each of her site in the communities. All this while she's learning a language that she's never studied before and admittedly does not come easy. The day before leaving, I was able to go to the capital with her - about 5 hours round trip - to buy medicine. A large portion of the money we had with us was from her patients. She charges 30 pesos each patient which is about 75 cents and contributes to the environment of dignity and respect that she's created. This allows people to take ownership of their health. Rachel's not handing out free meds left and right like a free for all. Patients have charts. They're instructed to come back for follow up. Rachel explains the 'why' behind everything she does instead of throwing meds at them, expecting them to take them, no questions asked. 

Rachel was so excited to buy meds because finally, finally she could buy what she wanted. She's been giving out meds that were donated to her, which she kept saying she was super grateful for, but weren't exactly what she wanted to have at her clinic. Instead of stocking things like vitamins, Tylenol, Advil, etc that people can buy inexpensively at the hospital pharmacy, she wants to have blood pressure medication. Parasite treatments. Anti fungal meds. Things that are harder and more expensive for her patients to get at the pharmacy in town, and, more importantly, things that require follow up. She wants to see her patients more than once. She wants those charts to become dog eared and full of info about each visit. She wants to see someone's blood pressure lowered week by week because the meds she's prescribed them are working. She wants to educate her patients on ways to control and manage and even prevent their illnesses. I spent a week and a half watching Rachel pour her heart into her work. Work that 4 years ago wasn’t even a thought in her head, but that now is her life. It was such a privilege and encouragement for me to walk alongside my sister, watching her live into what God has called her to as I do the same thing 3000 miles away. I am so thankful for our unique and beautiful friendship and can’t wait until we can work side by side again!" 

The gift of a friend...

The past week and a half has been a highlight in the DR for me....my close friend Hilary who serves as a missionary in California/Ensenada, Mexico advocating for a special ed orphanage was able to share her sabbatical time in the DR and serve right beside me, for 10 whole days!  Check out the link below to see pictures and read about our awesome time together...I may have guest blogged on her site...

Hilary Holbrook's blog

They came! They came!

This is proof.  My parents were in Jarabacoa!  Unfortunately the weather was a little less than pleasant....all my Dad's fears of the humidity were lay to rest as it was the coldest it's been since I moved here and rained pretty consistently.  But, despite the conditions, Mom and Dad were both found wearing shorts.  I on the other hand was bundled up the entire time.  My how quickly your blood thins out....

It was a quick visit but certainly enough for them to see several things...

1) People are poor and there is great need
2) I live in a comfortable and "safe" house
3) I have a great support system
4) Dominican drivers are worse than NY drivers
5) The roads I travel are difficult in the rain
6) There is nothing to do for fun, haha, ok, almost nothing

I hope and pray that my Mom left with her mind a bit more at ease and a little less worry captivating her Spirit!

The next two months bring a season of rest from teams before the summer begins and we have 3 non-stop months of groups.

I am greatly looking forward to having this time of rejuvenation.  Often as missionaries our attention is divided between speaking and living into the lives of American students who are serving alongside us and the Dominicans we are here to serve.  I am excited to focus solely on the Dominican aspect of my ministry.

The Lord has been stirring in my heart to really change the way I've been doing several things.  Please join me in praying about meeting the needs of two separate challenges.  The first being, of course, able to provide low cost, effective, on-going health care.  The second is offering affordable medicines so patients are able to actually stay on their medications long term and uninterrupted.

I'm excited to spend this time drafting up goals for my site, brain storming and hopefully improving how we can give good medical care.

I continue to be encouraged as each week I return to a community, a patient also returns for follow up.  It is such a blessing to bring medicine to remote campos and to patients who would otherwise go untreated.

If I may also ask you to pray about a Dominican coming alongside and serving at my site.  I'm in desperate need of consistent help by someone interested in medicine, who loves the Lord and is good with people.  I'm praying about hiring a nursing or medical student to help me in the communities.  It's so exciting to see how my site has grown in only 3 months!  To think I already need full time help!

Thank you for your continued love and encouragement, please know it doesn't go without notice.

Ethical Dilemmas

The perils of an American health care provider attempting to see patients in another country, in another language, with many different obstacles.....

Yesterday, I partially discovered why I love Wednesdays.  Its not just because I'm immersed within the Haitian culture.  Or because these patients truly need medical care.  Or because, well, a big part of my heart is with them.

It's because I can practice in depth, complex medicine.  Why?  Because I have a translator.  A translator who can ask them the complicated questions.  A translator who is Haitian himself and can place our patients at ease when asking personal questions.  Or who can help me understand my patients reasoning's for eating "mud pies (yes, actual baked mud) " during pregnancy.

With Dominicans, who consume the other big part of my heart, I am going it alone.  Therefore, my questions and explanations are simple and in broken Spanish.  I feel as if I'm not always delving deep enough into their histories or complaints, bc, well frankly at this juncture I can't.  And so,  I still don't understand why people drink a cup of limes when they have a cough- guess that's something I should ask my Dominican friends?

Entonces.  Every day I am challenged.  Every day I feel inadequate.  In the states I practiced oncology.  I treated and walked with the sickest of the sick.  I practiced hard and intense medicine.

And what am I doing here?  Half my patients simply desire cold medicine, or pain relief for a headache.  Complex, challenging medicine?  I think not.

But do these same patients deserve to have Tylenol cold when sick and Aspirin for a headache as we do?  Should they be deprived of symptomatic relief simply because of their economic status?

Is primary care in the states the same?  Many patients desiring remedies for common viruses?  Probably.

But what am I to do when it seems I am being viewed as simply a pharmacy, because many times I provide medicine during my patient's office visits?

How do I provide comprehensive, good quality medicine to the poor without creating a dependency?  What happens when I run out of my donated medicines?  Will the patients still come?  In a place that values what I physically give them, such as medicines, higher than my medical recommendations?

And how do I undo the damage that free clinics in our communities have already done?  Free clinics that have the purest and best intentions but ruin the relationship I am so desperately trying to create.  A long lasting relationship with routine medical care.

"Why must I pay to see you when once or twice a year other doctors from the states come and provide free care?" said a patient in Coracito on Tuesday.

Our nominal fee (the equivalent of 75 cents) allows our patients to have accountability, dignity and enables me to buy more medicines.  But how can we teach responsibility when other do-gooders impair our relationships?

I thought when I left oncology the ethical questions and challenges would evaporate but clearly that isn't the case.

So how should I proceed?  Consume myself in feelings of defeat and lack of purpose?

I'm not going to lie and say I haven't had thoughts like these.  But as I do, and as I desperately seek within my bible and with cries of inadequacy to Christ, tangible encouragement is given.

~A wonderful conversation with Dr. Fernando, the Dominican Physician I serve along side who is pleased with my organizational skills or how we routinely practice in the states- each patient who presents at our clinics has a chart complete with a medical history and follow up.  This simple record keeping that we take for granted has allowed us to effectively treat patients which hasn't been done in rural clinics previously.

~Two letters from previous students who went back to the states rejuvenated with a deeper faith walk and new possible vocations.

~And Brian Entrekin our incredible, faith filled leader offering encouragement with this simple word this morning.  Time.  And he's right.  

With time and continuity and love and open-mindedness and faithfulness my site will become what it should be, frustrations and all.  Noone said this was going to be devoid of challenges.....but suggestions I will accept :)