I stared at the face of death on my patient's face today...and cried...

My ministry revolves around hosting medical clinics and teaching HIV/AIDS classes.  Each clinic I can typically see about 25 patients in that time frame - this allows me to do patient education, which is what my heart loves.

Today I was able to tell a diabetic the way to change their diet which will change their life.  My patient, who has been a diabetic his whole life (needs insulin), had never received any type of this information before.  In a country where the primary item on every dish is cups and cups of rice - this was hard information to process, but he listened intently, asked some great questions, and we both felt good about it as he left.

About half way through my day a young 22 year old young mom with her 4 month old baby came to see me with "constant fever."  Each patient here is responsible for their own medical information.  They carry around with them their "cuaderno" - or their notebook - where the doctors write down their visits, exam results, and the prescriptions they give them.  The hospital does not keep medical records on the majority of their patients - this is the responsibility of each person.  Upon reading her cuaderno, it became evident that both she and her 4 month old baby were HIV positive.  So I had to ask the next question - Are you taking your meds?  To which she replied with a quavering voice, tears in her eyes, and without eye contact - No.

I took a deep breath - not because I was frustrated, not because I was angry, but because as I looked at her, I saw the look of death across her face.  I saw hopelessness.  I saw a young woman in her prime taken down by this disease, and my eyes wandered down to her baby as well.  I took the deep breath because I needed time to think through this and figure out a way to help her, give me time to process.

So I talked about how beautiful she was, and how much life had to offer her.  I told her that her baby needed his mother, and she needed to see her son grow up.  I held her hand and made her look into my face as my own eyes welled up with unshed tears. I told her I wanted to see her live!  To not look death in the face - to let the medication do it's job and how she could live for many decades more.  But...she said...she could "sneak" her baby in to get his meds at the hospital, and no one knew, but when she want to "that place" everyone knew why she was there, and she just couldn't bare that.  She knew what people were thinking about her, and how ashamed she was.  She "knew" it was HER fault (her words). She knew the inevitability of her death, I could see it in her face...I could see the hopelessness and the helplessness.  I could see that she knew it was only a matter of time - her face told me this with her single look of despair.

I told her that this is when she needed to be courageous - if not for her, then for her baby.

She gently nodded her head, with her head bent deep, staring absently into the folds of her skirt.

I softly lifted her chin with my shaking hands, so her eyes were looking at mine.  And I said to her - "You need to not just say it...you need to make me a promise."  She looked back, and didn't say anything...her eyes were darting back and forth to my eyes - trying to understand what I was asking, and her mind was trying to decide what to do.  She finally looked at me...."yes...I promise."  "You promise what?" I whispered in response to her comment.  "I promise to you that I will go to the hospital and start taking my meds."

It was all I could do.  I kissed her cheeks, she stood up, with her baby in tow, and I bent my head, and the unshed tears came streaming down my cheeks.  To feel so hopeless, helpless, rejected, and unloved - her lack of her own self-worth radiated from her as he walked away. She arrived alone, just she and her baby, and was leaving alone.  Abandoned and uncared for.   And I was burdened.  My heart ached...I felt it in my bones!  If I could have done anything else I would have...but what I had done that day was give her a hand to hold, a kiss on the cheek, and tears to help share her burden, if just a little, and to tell her as much as I could that she WAS worth something...that she DID matter...that she was a child of God and had so much left to give. And she made me a promise...

I pray it was enough.
  

When you are the "expert"

I found when I was in Honduras, that the title of "nurse" just didn't cut it.  No matter HOW many times I told people I was a nurse, my patients would refuse to call me that, and always referred to me as "Doctora Teresa" (my middle name I've always used).  Ultimately I gave up, and just responded to how people addressed me.  I think it really was more an acknowledgement of how much I know.  I have done my utmost to educated myself well beyond what I learned in Nursing school, and my 13 years working in a hospital.  I've gone to week long trainings, seminars, read more books than I care to acknowledge, been to medical symposiums, break-out sessions on topics that are "hot" in my area, and am only a few months away from getting my Masters degree in Public Health.

However, even with all that, I can't help but feel the burden of being the "expert" in a field.  I have taught on HIV/AIDS, will have a 30-hour class on the topic, will be doing another church-wide event on the topic, and have bi-monthly medical clinics where I am heavily involved in patient education.  I do NOT profess to be an expert in pretty much anything...but I'm highly educated on a LOT of "stuff".  Because of that, that means I am typically the most educated around (in health care issues, that is).  My class that started out as 9 students, has morphed into 25 students.  I have a student handbook that I created, have a text book we are using, and I'm having the students devise an HIV/AIDS outreach program within their church as their "final project" for my class.

We have, once again, found ourselves figuring out things on our own.  Our team mates returned to the U.S. only 2 months after we arrived, so we were left to figure out things for ourselves - but our time in Honduras prepped us to be able to do just that.  We arrived in Honduras by ourselves, and left with a HUGE team taking over.  So - God prepared and equipped us to be able to do that.

However, I won't deny the stress and burden that that brings with it.  I have people knocking on our door almost on a daily basis asking for medical help - organizations looking how I can help out - churches asking for classes and health education - the list is endless, and honestly, my days would be filled with just that if I let it.

However, I must find a balance.  I do work for free, after all.  Regardless of how much work I do or don't do.  When a missionary goes on the field, they go as a "unit".  That  means that one person is paid.  Typically that means that the spouse (wife) is primarily involved in the hugely important job of caring for the family on the mission field, but they typically have only a small involvement in the ministry.  For me, that's always meant something else.  I've always been a mom, a wife, a nurse, and 10 other hats.  And my full-time job means working for free.  On the mission field that looks like a full-time ministry partner.  This is a unique place, and not one that many other "units" experience.  Don't get me wrong - there are certainly other missionary units that have working spouses, but this is the exception, not the norm.  But the bottom line is - if I wanted to make money, I would not be a missionary - I'm not here because I am looking to make money - I am here for a different reason entirely - to be obedient for what God has for me here, in this place, at this time.

And so...I guess I will be the "expert" in my field, and do my darndest to pass that information on to others.  To educate others on how to change their life, their diet, and reduce their risks of becoming infected with HIV - the number 1 cause of death in this little country.  With the average life expectancy is 57, where your odds of dying before 5 are one of the highest in the world, where your odds of becoming infected with HIV and dying from AIDS are the 14th highest in the world...yeah...I guess me becoming an "expert" in the field is important after all.

My quest to save one life at a time

When I went into missions I had this grand idea about what that would look like.  I envisioned transforming communities with clean water, deworming all the kids, vitamins to the malnourished, malaria meds to one and all, and everyone eating a good/balanced diet.  Yeah...that was through the eyes of a naive / new missionary.  Within a year of me being in Honduras I realized the futility of that.  So I changed my vision and changed my heart and looked past what I wanted to what was needed.  Yeah...I know....good plan, right?!

It was then that I realized - I'm NOT going to change the world.  I'm NOT going to change a community, but I CAN change one person at a time.  I can make a difference in ONE life - and that became my new goal - my new passion.  I would still serve everyone who came to my door...everyone who came to my clinic...and I would treat no one differently than another.

But it is frustrating.  I have to admit it!  When I see the same people coming for the same reasons, and if they could but make a few life changes, they could turn things around.  My LEAST favorite section in nursing school was Public Health. I admit it!  I didn't buy into it...but I was young, and didn't see the value for what it is.  But now I am pursuing a Masters Degree in Public Health, Population Medicine, and will have completed this in less than 6 months time after almost 4 years (a class at a time) of pursuing it.  And public health is my passion.  Look how far I've come :-)

So I teach.  I educate.  I inform.  And if someone chooses to implement these changes or not - at least they do it with the information I've given them, and they have made a conscious decision to do it or not.  But it still surprises me.  After 9 years on the mission field, and doing medical missions for that long, when someone does do what I tell them.  And it's a moment to rejoice!!!

Case in point.  One of the pastors we work with, a board member of the seminary where Mike and I teach, and the first clinic we put on here, came to me at the end of the clinic and asked to have his blood pressure taken.  He is 48 years old.  My age.  Let me put that in perspective.  The life expectancy in the U.S. is about 80 years old, in Honduras it's about 75, but here...where we live...,it is 58 years old.  That means in 10 years, he will most likely be dead.  We long to have a good/robust life - to see our children grow up and experience lives with our grandchildren.  For the majority of the people here, that is not even a reality.  I contribute it to genetics, diet, and just the stress of living.

So this sweet man came to me, and I took his blood pressure - and it was through the roof.  So I started my inquiry into his life.  His diet, his home life, etc. I came up with a plan, and the education started.  For about the next 30 minutes I gave him practical every-day advice on how to adjust his diet, reduce his stress, and started him on some base-line meds.  I told him he must return every week for me to follow-up with his blood pressure.  I told him this, knowing the probability of him returning was slim to none.  I've been here before.  A LOT of times.  I've had the SAME conversation over and over and over with so many people, I can't even count.  But it doesn't stop me.  I'll keep saying the same thing - and keep giving people the same information in the hopes that one day - maybe - someone will actually listen!

So...I waited.  And I got a knock at my door the following week.  It was the pastor.  Come to get his blood pressure checked.  And I took it -it was better...but still not great.  So we talked about his life - his diet - what things looked like.  And we poked and prodded until we came up with a slight revision in the plan.  And I told him to come back the following week.

So...I waited.  And I got a knock at my door the following week.  I sat him down, and we talked for a bit.  Then I took his blood pressure...and the delight that came across me I couldn't contain!  It was all but "normal."  He KNOWS I am not a heart doctor, nor a specialist of any kind - just a well educated nurse trying to make a difference.  But he has so few options, and I was his "best" hope.   We looked at each other -and the joy couldn't be contained.  I lifted my hand for a High-Five, because I couldn't help myself - then the joy spread to him.  He beamed from ear to ear, and we sat in silence, and yet shared this moment of victory...at least for now...This sweet man just had his 10th child, and I long for him to be able to experience life with them - to not suffer from the primary cause of death not associated with disease in this country.  To live long after the "normal life expectancy."   And that maybe, just maybe, I can help save a life...one at a time...just one more...just one more!  Until my time here is done, I will continue in this pursuit.  And how I LONG to hear...

Well done, my good and faithful servant!