A Christmas Reflection

Snow and "It's a wonderful life" are not my things. Ok, I don't mind snow for a limited time frame around Christmas; I just don't really miss it. The movie "It's a wonderful life" on the other hand, I find painful to watch. This was apparent grounds for one of my colleagues to ask me, "Do you even like Christmas?" (To her credit, I may have overstated my case with "It's a wonderful life" saying that it made me "suicidal".) In response, I told her that I'd soon be stealing Christmas trees.

It's not every day that I have to defend my love for Christmas, but it made for a good laugh and made me a bit reflective about what I DO miss about Christmas in the States. This December will be my third Christmas in another country (not successive), and though I miss family and all the holiday traditions greatly, there is something about "remaking" Christmas that I really enjoy.

The distance that Mali provides from my typical Christmas celebrations, enables me to reflect better on the earth-shaking reality of what happened that day 2000 years ago. In the sadness that comes from being away, I'm forced to celebrate, not in the happiness of all the accessories we've added to Christmas, but in the joy of His birth.

His birth shapes our life purpose and is what has brought me here, to the other side of the world. His birth allows me to have a new family here, not of blood, but of spirit. It speaks of transformation and change in a world dead-set on self-destruction. It breathes joy into a world full of hurt. His first coming gives light enough to see the glorious hope that is His second coming, when a world full of injustice and evil will be set aright. I have trouble imagining a place that makes these realities more crystal clear.

But it goes even one step further in remaking our existence, and it is this step that has been brought back to mind this morning.

Earlier this week, Christianity Today carried a quote from a pastor in Pennsylvania who spends 7 months a year in Uganda as a mercenary trying to hunt down Joseph Kony and leaders of the Lord's Resistance Army. (Where does he get the finances for this?) As just the latest in a string of quirky pastors doing off-the-wall things, he stated that people opposed to his work were just thinking too much of the God of the New Testament.

I mean the irony is so thick I'd have laughed hysterically, but for the fact that I too once wanted to do the same. In my junior year of college, I did some research on the LRA and Joseph Kony. The evil and atrocities of that organization (mass murder, rape, and child soldiers to name only a few) are sickening and frankly, enraging. On a run with my good friend Adam Thada, I proposed the idea that we ditch college and train to become "Christian Mercenaries." It made for a fun conversation during our run and a good joke afterwards, but we didn't seriously entertain the idea for long because our theology didn't permit us and neither of us would have made great mercenaries.

When I saw that quote, I immediately copied it into an email to Adam, who is currently working in Bolivia with an organization that provides dignity and a way-out for women trapped in the sex trade. Tongue-in-cheek, I lamented the fact that someone had beaten us to the punch and that if only we'd known we just needed to ignore the God of the New Testament, we'd be doing the same thing. I further complained that we had, since our college days, gone soft, him working with prostitutes and me with sick children.

However, that is precisely the point. When God chose to do His most important work in the world, He started with the humility and vulnerability of a child and completed it not as a military-commanding king, but with submission even to death. His is a Kingdom of love, charity, hope, and humility, and these characteristics rarely seem "winning" in this world. Yet, Christ's birth does not leave open to us the option of accomplishing the work of the Kingdom in typical "winning" fashions—coercion, dominance, and deception. His birth dictates to us not only what we do with our lives, but also how we do it.

Don't get me wrong, the elimination of the Lord's Resistance Army would be a great advancement in the world of social justice, but in light of Christmas, becoming a mercenary to accomplish this feat seems a bit wrong-headed.

This Christmas season, I'm finding that the story of His humble birth is continuing to remake my ministry here in Mali. I would be lying to say that our work here progresses without hitch and that we've only got winning stories. We have medical errors, sometimes repeatedly. With some in our staff, we've got lack of buy-in to the vision. Antiquated and dangerous ideas and attitudes persist. We have cross-cultural conflict and inefficiency and poorly structured systems.

And in such a milieu, Christmas reminds me that during moments of frustration, departing from the way of love, charity, hope and humility, even to accomplish the good, is to be off-track and wrong-headed. It is far more Grinch-like than disliking snow and "It's a wonderful life."

"Truly He taught us to love one another,

His law is love and His gospel is peace.

Chains he shall break, for the slave is our brother.

And in his name all oppression shall cease.

Sweet hymns of joy in grateful chorus raise we,

With all our hearts we praise His holy name.

Christ is the Lord! Then ever, ever praise we,

His power and glory ever more proclaim!

His power and glory ever more proclaim!"

O Holy Night

Just a name?

(Another update letter story, here for blog readers who might not get those letters.)

Her name was Trash. Had I been more in-tune with what little Bambara I know, or perhaps not in such a frustrated hurry, I would have noticed that on her chart. As it was, she came to my door in the midst of a busy morning. To add fuel to the fire, she was persistent, a bit feisty, and she lied right to my face. She told me that Dr. Dan had sent her to me so that I could do a dressing on a wound that she had. Having just talked with Dan, I knew this to be a lie. (Not uncommon around the hospital when people are trying to work the system.)

I chastised her for lying, then took one look at her wound and knew she needed surgery. Looking at her chart, I realized that she had started treatment at our hospital, when the wound was smaller and more manageable but had skipped all of her follow-up appointments for two weeks. In my medical eyes, she wasn't winning any brownie points.

I tried to put her back in the consultation system to make sure she was seen by the physician with whom she had had the follow-up appointment. I even asked one of the nurses to personally see that she was taken to the right office. However, thirty minutes later she showed up with a note scrolled on her chart that she should see me for a dressing change. The writing was not that of any of our doctors, so I knew it to be another attempt to work the system.

I was truly frustrated, but fortunately medical ethics that are drilled into you in American healthcare insist that you don't have to like the person or feel nice, but you do have to take care of the problem. So I grumpily went about solving the problem. I took her to Dan and we told she would have to stay and have surgery that afternoon, after everyone was done being seen in consultation for the morning. It was evident that she wasn't happy with this solution.

When we were finally ready for surgery, she was nowhere to be found—a quiet, but definitive statement about what she thought of our solution to her problem. So it was quite a surprise when she showed up again a week later. Again, she came directly to me, instead of going through the proper channels. I decided that this problem needed to be handled by a Malian, if for no other reason than I was losing all patience.

So I took her to Rebeka, one of our Malian physicians and explained the situation. I left the room as Rebeka was asking her why she had skipped out on all of her appointments. I was relieved that the responsibility was off my shoulders, and felt like exacerbatedly saying, "People! Hmmph!"

Fortunately after I closed the door, Rebeka noticed the woman's name. Realizing there must be more to the situation, she began asking questions. Her tragic life story unfolded—she was born to a mother who had lost all her other children. Convinced that demons were to blame, she named the little girl Nyama (Trash) to show them that the child had no importance. She was neglected in her childhood, given just enough attention to survive, so as to prevent the demons from thinking she was valuable and taking her away. She was married into an unhappy situation, money was tight, and when she developed this infection, the husband wasn't inclined to help her get treatment. She skipped all her appointments because she didn't have the resources to get to the hospital or pay her bills. Manipulation and lying were the only options she felt she had left.

When I heard her story I was heartbroken and humbled, but was very happy to hear that Rebeka convinced her to stay at the hospital, have surgery, and finish treatment. (Financed by our fund for impoverished patients.)

I was reminded of Philippians 4:5, "Let your gentleness be evident to all. The Lord is near." Please join me in praying for women like Nyama who are in such difficult situations. May they receive treatment, love and dignity at our hospital. Pray also for us as workers that God would give us eyes to clearly see the life situations of our patients.

A moment of privilege

A repost from my regular update letter, for those blog readers who don't get that letter.

"Please Lord, don't let him be dead," I whispered as I hung up the phone. I tried to reprimand myself for thinking so tragically, but this time of year tragedy is in the air, and sometimes it is catchy.

I was in the OR, doing I-don't-remember-what, when one of the nurses from pediatrics called me to tell me that Daouda's dad was here to see me. And I worried that such a visit could only mean bad news, since the family is quite poor and they live a good distance away.

Daouda, as some may remember, is a 9 year-old patient that came to us last year. He had been burned on the face and neck a few years prior and the resulting scarring was pulling his lips all the way down to his collar bone. Brett, the pediatrician, rightly said that it looked like the Picasso painting "The Scream."

Since then, we have done several surgeries on Daouda, with the help of many visiting surgeons. Though the scarring is still evident, he now has good movement in his neck, mouth, and face. He no longer has to wear a ski mask to cover the deformities.

During his last hospitalization, Daouda really grew attached to the staff and was having the time of his life playing with everyone who had a minute to just hang out. (They took to calling him the king of pediatrics.)

In early September, Saskia (the Dutch physician), Lazar (a Malian pediatric nurse), and myself took a trip out to Daouda's village just to visit with him and his family. He seemed to be doing really well.

So after hanging up from the call, I started walking towards pediatrics to find his father, hoping that he hadn't succumbed to malaria after all this.

But I was happy to see Daouda peek around from behind his dad as I approached. I greeted them and then took them to my office to talk. After some small talk, it became clear that the father was there to ask for help for something. He handed us a letter in French, which Jessica and I struggled to fully comprehend, but it was clearly a request to help send Daouda to school. He had never been allowed to go to school because of his deformity, but the family wanted him to start this year.

After pulling in another a Malian peds nurse (also a mom who knows about Malian school), we figured out that the request totaled a little less than $20 to cover the whole year of school, all his supplies, and even their transport to and from the village. We even purchased his supplies that day and sent him on his way with his notebooks, pencils, chalk and chalkboard all stuffed in a puppie-dog backpack. He was so happy as he skipped away that day... and I...well, I felt like a million bucks.

I tell this story not to pat myself on the back (you'd have to be a scrooge of the first order to NOT have given $20 to send this kid to school), but rather to tell you that I'm so privileged to be here. There are days when the busyness and the challenges of this place cloud my sight of that privilege, but there are moments of clarity which make the heart sing.

And I want to thank you for all your prayers, encouragement and support. You are truly a part of this ministry, and I hope you can celebrate in joy with me over these moments of privilege!