A Different Way of Doing Medicine

Medical / Health

I was only fourteen when I decided I was going to become a medical missionary. In my fourth year of medical school, when it was time to decide where to spend my elective term, I assumed I would be going to Africa – back then I thought all missionaries went to Africa.

But I was surprised to learn that female medical personnel were most needed in Muslim countries, where many women died because there were no women doctors to attend them.

So I ended up doing my medical elective term at the Pennell Memorial Hospital in Bannu, north-west Pakistan. It was in a compound with high fences and armed guards. Women were not allowed outside the compound alone, and we had to cover every part of our body including our head. I have pictures in my mind of old rusty beds, surgical gloves hanging out to dry after use, hot sweet tea and lots of kids with thin mums. Women would travel great distances to come to this hospital, some even on horseback from Afghanistan, to see the famous obstetrician Dr Ruth Coggan.

Stomping on Baby’s Bottles I started to think about holistic health and doing medicine in a different way, after I witnessed a nurse at Pennell Hospital stomping a baby’s bottle under her foot. Her strange action started making sense after I learned that bottle-feeding contributed to the malnutrition, infection, growth retardation – and even the death – of babies there.

Big multinational companies sold their milk formulas cheaply, and promoted bottlefeeding as the way of the West, until it became a common belief that good mothers bottle-fed rather than breast-fed. However, many poor village women watered down the formula to make it last longer, depriving their babies of the nutrition necessary for growth. Not only that, the lack of clean water and inability to sterilise bottles frequently led to infection and diarrhoea, then dehydration and death.

My brief time at Pennell Memorial Hospital taught me so much. I learnt the importance of preventative and community medicine. I learnt that even though curative hospital care was exhilarating and necessary, prevention is better than cure. I began to understand that people’s health is more than physical, and that it is bound to their poverty, education level, status, economic means, gender and religious beliefs. In short, I had begun to understand about holism.

I probably could not articulate it at the time, but it was there I first understood that being healthy is not as straightforward as I had previously thought. As I began to consider the type of medicine I wanted to be involved in, it was very clear that, even though I enjoyed hands-on healing, my future lay in primary health care, community medicine, teaching and training.

Theological study I reached another turning point in my Christian journey in Pakistan. While visiting Multan Christian Women’s Hospital I had the opportunity to go on an evangelistic ward round. The hospital evangelist would share the gospel with the captive audience of the patients’ friends and relatives, who stayed there to care for, wash and feed the patient. I thought it was great that the gospel was shared, but I was uncomfortable with the division: doctors dealt only with the physical, and evangelists dealt only with the spiritual. I didn’t want to restrict myself to being only a doctor; I wanted to share the message of Christ myself, and to teach from the Word of God. I realised two major things then: I did not want to do medicine full-time, and I was going to need more theological training than I’d previously thought.

So in 1990 I began full-time theological study, while also working part-time as a GP to help pay my bills. After I finished my theological training, I worked in churches and as an itinerant speaker, still juggling that with part-time GP work. During this time of doing two jobs I was able to reflect on the interaction of the physical, emotional and spiritual. I also did a counselling course which was based on an integrated understanding of the person. We are complex beings and being healthy is a complicated business. Our emotions, hidden or conscious, have a powerful effect on our wellbeing and our perception of the world, and the way we impact others.

Community development When I applied to become an Interserve Partner, I was willing to go where I was most needed. That turned out to be Central Asia, where the church had grown exponentially since the fall of the Soviet Union, but leaders were young in years and young in faith. I would be serving there as a General Practitioner training other GPs.

This role was a concern to me. Even though the GP training programme was vitally important (it was part of a reform of the whole health system from being very hospital based to one that is more primary health care based), it was not the grassroots, community-based medicine that I wanted to do.

My first year there was focused on learning Russian, but I also attended community development training. This was another significant turning point, as I caught the vision of impacting communities in a holistic and grassroots way, where they could be empowered not only to recognise their own problems, but also to solve them with local resources.

By the time my language learning ended, there was a breakthrough in my work situation: my organisation decided to start a community development department. It meant that I got the opportunity to work in a small team that, among other things, did health screening and trained village health workers. Working in the project team was quite a cross-cultural experience, with sometimes four languages needed for everyone to understand what we were going to do, or what we were thinking. I would say something in Russian, for example, then my Russianspeaking friend would translate it into the local language for my Korean colleague to understand, then she would say something in Korean to her husband, and he would then respond in English! It was a wonderful experience, but needed lots of patience.

Initially there were two doctors (myself and another) available to meet the villagers’ needs: we would see patients in the morning, then move on to teaching the local health workers how to prevent and treat common problems. However, I came to realise that I was undermining what we were trying to achieve in the project: as long as there was a doctor available, people wouldn’t bother to learn how to prevent the problems themselves. That is when I decided my main role would be to train and coordinate the work of our community development workers, rather than be directly involved in the community myself.

We had a few different ways of selecting communities and entering them. One involved doing health screening at schools and then presenting the findings to the parents at a public meeting. We then offered to help them, but made it clear that we offered training, not money. We began by training the people in identifying needs and problem solving. Our lessons covered many topics, such as physical health, income generation, agriculture, emotional issues and moral values like honesty and forgiveness.

Sometimes we were able to incorporate stories from the Bible in our teaching. One very powerful lesson on forgiveness was taught by using the story of the prodigal son, but adapting it to ‘the prodigal daughter-in-law’. This seems to be the relationship with the most strain here, the one between the wife and her husband’s mother. Wives go to live with their husband’s family, and the wife has to do the bidding of the family matriarch – her mother-in-law. Most women are not free from this until they become mothers-in-law themselves. We saw many people recognise the destructiveness of unforgiveness after this lesson, and many were willing to do the homework we set them, which was to forgive someone!

Most of the communities we worked with knew we were followers of Jesus, and through years of interaction they developed a more positive understanding of Christianity. We do this work not as a means to evangelise or plant churches, but because it is good in itself and demonstrates the love of Jesus to broken people. In many places around the world, however, the natural consequence of such holistic community development is that, over time, churches are planted.

TEE and discipleship A great number of local church leaders, when surveyed, said the biggest need in their church was for discipleship. The local church is great at evangelism and church planting, but after people turn to Jesus there are many obstacles that prevent them from growing in their faith. Many groups are started in small and isolated communities as people respond to the good news, but without local leadership they often go for months without receiving any biblical teaching.

Theological Education by Extension, or TEE for short, addresses this issue. Group members can study the Bible wherever they are. Books of self-study material become the tutor. Someone needs to know how to be a facilitator or group leader, but basically the group learns together, has home-study tasks and practical ministry assignments.

In my last term overseas I was asked to help develop a TEE programme for one of the Bible Colleges. A few of my former students were keen to work with me on this, as they realised that TEE was the best way to help the church grow, especially in remote areas. Mars, a gifted church planter, used to be a Muslim mullah until he encountered Jesus as he was saying his prayers. As Mars began small groups, he found he didn’t have the time or resources to follow them all up. Now, through TEE, the groups are provided with the resources they need to grow in Christ.

We have a big vision for our TEE groups: we want to use them to address the needs of the whole person. We plan not only to offer theological training in these groups, but also to pass on life-skills and knowledge in the areas of health, parenting, intensive gardening, income generation and so on. It is our hope that group members will become lights in the community which others are drawn to and want to learn from. This is still in process as change is slow.

When there is harmony between people and God (the spiritual dimension), among people (the social dimension), within the person (the emotional dimension) and between people and their environment (the physical dimension), we have holistic health. Illness is a breakdown of these relationships. As Christians we work to reveal the reconciliation that Jesus achieved through His death on the cross. He is Lord of all and has reconciled all things in heaven and earth to Himself (see Colossians 1:15-20). If He is Lord of all, He is Lord of every aspect of this world and of our lives. That’s holism.

Lyn Pearson is Interserve’s Regional Director for East Asia and South Pacific. She lives in Australia with her husband and two sons.

/작성자:

The little ones

Medical / Health

This evening ritual is not limited to the herding of turkeys, however. To go out at this time of the evening is to risk being caughtin ‘peak hour traffic’, country style, as cows, goats, sheep and donkeys return from their day of grazing on the hills. Most herds are a mixture of all of these animals, and most come from a number of different homes. Yet, somehow, as several children run along behind, ensuring no stray is left behind, each animal seems to find its way into the correct yard as the herd goes by.

Though this may sound like a story about animals, it’s actually about the children. As a paediatric nurse I hold children’s issues close to my heart. For the past few years I have been working in a project that provides health care in an isolated, geographically challenging area of Central Asia. In that time I have been struck by the high number of children who are brought to us with serious health complaints, often too late for us to make any difference, or with diseases and conditions that would be easily treated or prevented back in New Zealand. I have often become angry about what I considered to be cases of blatant neglect. However, it almost never turned out to be quite that straightforward: what I perceived as neglect was a complicated mix of desperation, ignorance and accepted cultural practices.

Sitara was a beautiful nine-month old girl, just old enough to crawl… and just old enough to fall into the family ‘tandoor’. The tandoor is an in-ground oven, hot enough to cook bread quickly, and when Sitara landed on her elbow, she suffered full thickness burns which exposed the joint. The burn was over a week old and infected when I saw her. Her father had taken her to the local clinic nearest their home, but when informed that the clinic was not equipped to deal with such a severe burn, he had refused to take her to our hospital.

I re-dressed the burn, but explained to the family that, at the very least, Sitara would need skin grafts. Indeed, she probably would require even more radical surgery, which we were not able to do. I referred them to a children’s hospital in the capital city, about 450 kilometres away, but Sitara’s father was reluctant to make the two-day journey, claiming hardship and poverty. I continued to impress on them the severity of Sitara’s situation and the necessity for further help, and they finally agreed to go. When they said they did not have the money, I eventually agreed to help with transport costs.

Although my heart grieved at the inevitable disability little Sitara would have to live with, I was confident that she would receive good care at the children’s hospital in the city. However, as days turned into weeks and we received no word of the family’s arrival in the city, I realised that the family must have decided not to go, and had instead taken their little girl home, most likely to die.

My feelings of helplessness and anger were overwhelming, as I struggled to make sense of the situation. One thing that helped was putting myself in the father’s shoes: what factors influenced his choice to take his seriously ill daughter home instead of to the hospital? I believe there were several: they were an extremely poor family and, even with assistance, it would have been an expensive trip which he had no real way of financing; he had never been to the city before, and the thought of travelling all that way for a treatment that, in his mind at least, would be unlikely to save her life, probably seemed pointless; he understood that losing children was inevitable – he had already seen several of his children die in infancy; he had other
children to provide for, and in his absence there would be no-one to take care of his family and his small piece of land.

For many families the decision about whether or not to seek treatment is complex. It involves the gender of the person – sadly it is still true that often women and girls will have to wait longer before they receive any form of health care; the time of year – spring and early autumn are difficult times of the year due to planting and harvesting crops, winter is difficult due to snow and higher river levels; distance from the health facility; the financial status of the family; the perceived value of the person who is sick; and religious and cultural beliefs.

I have also learnt that the clinic or the hospital is rarely the first stop for a child who is ill. The family will usually take them first to a local ‘healer’ in their own village, then to the nearest mullah (religious leader), who will provide prayers and talismans, depending on how much the family can afford. Finally, if none of that works, they may then take the child to ‘the doctor’. All of these steps are important, culturally and spiritually. There is a habit and a pattern to what is accepted and expected, and if the pattern is not followed and the child remains sick or dies, then the one who made the decision to not first consult the local healer and mullah will be blamed.

Working through it in this manner helped me to better understand the complex situations I was dealing with, but of course did not change the sad reality for little Sitara or the reality for many other children like her. In a country where one in four children will die by the age of five years, it’s easy to get the impression that a child’s life is viewed as of very little worth. But I have seen the agony as a father pleads for some action
to be taken to save his precious son or daughter, and the pain behind the fatalism of parents accepting the loss of yet another precious life. And all I can hold on to in those situations is the hope of a Father who sees when even one sparrow falls, and who will not forget these little ones, or those who mourn them.

Kelly is a Kiwi Partner and a nurse, who has been serving in Central Asia for six years.

/작성자:

The little ones

Medical / Health

This evening ritual is not limited to the herding of turkeys, however. To go out at this time of the evening is to risk being caughtin ‘peak hour traffic’, country style, as cows, goats, sheep and donkeys return from their day of grazing on the hills. Most herds are a mixture of all of these animals, and most come from a number of different homes. Yet, somehow, as several children run along behind, ensuring no stray is left behind, each animal seems to find its way into the correct yard as the herd goes by.

Though this may sound like a story about animals, it’s actually about the children. As a paediatric nurse I hold children’s issues close to my heart. For the past few years I have been working in a project that provides health care in an isolated, geographically challenging area of Central Asia. In that time I have been struck by the high number of children who are brought to us with serious health complaints, often too late for us to make any difference, or with diseases and conditions that would be easily treated or prevented back in New Zealand. I have often become angry about what I considered to be cases of blatant neglect. However, it almost never turned out to be quite that straightforward: what I perceived as neglect was a complicated mix of desperation, ignorance and accepted cultural practices.

Sitara was a beautiful nine-month old girl, just old enough to crawl… and just old enough to fall into the family ‘tandoor’. The tandoor is an in-ground oven, hot enough to cook bread quickly, and when Sitara landed on her elbow, she suffered full thickness burns which exposed the joint. The burn was over a week old and infected when I saw her. Her father had taken her to the local clinic nearest their home, but when informed that the clinic was not equipped to deal with such a severe burn, he had refused to take her to our hospital.

I re-dressed the burn, but explained to the family that, at the very least, Sitara would need skin grafts. Indeed, she probably would require even more radical surgery, which we were not able to do. I referred them to a children’s hospital in the capital city, about 450 kilometres away, but Sitara’s father was reluctant to make the two-day journey, claiming hardship and poverty. I continued to impress on them the severity of Sitara’s situation and the necessity for further help, and they finally agreed to go. When they said they did not have the money, I eventually agreed to help with transport costs.

Although my heart grieved at the inevitable disability little Sitara would have to live with, I was confident that she would receive good care at the children’s hospital in the city. However, as days turned into weeks and we received no word of the family’s arrival in the city, I realised that the family must have decided not to go, and had instead taken their little girl home, most likely to die.

My feelings of helplessness and anger were overwhelming, as I struggled to make sense of the situation. One thing that helped was putting myself in the father’s shoes: what factors influenced his choice to take his seriously ill daughter home instead of to the hospital? I believe there were several: they were an extremely poor family and, even with assistance, it would have been an expensive trip which he had no real way of financing; he had never been to the city before, and the thought of travelling all that way for a treatment that, in his mind at least, would be unlikely to save her life, probably seemed pointless; he understood that losing children was inevitable – he had already seen several of his children die in infancy; he had other
children to provide for, and in his absence there would be no-one to take care of his family and his small piece of land.

For many families the decision about whether or not to seek treatment is complex. It involves the gender of the person – sadly it is still true that often women and girls will have to wait longer before they receive any form of health care; the time of year – spring and early autumn are difficult times of the year due to planting and harvesting crops, winter is difficult due to snow and higher river levels; distance from the health facility; the financial status of the family; the perceived value of the person who is sick; and religious and cultural beliefs.

I have also learnt that the clinic or the hospital is rarely the first stop for a child who is ill. The family will usually take them first to a local ‘healer’ in their own village, then to the nearest mullah (religious leader), who will provide prayers and talismans, depending on how much the family can afford. Finally, if none of that works, they may then take the child to ‘the doctor’. All of these steps are important, culturally and spiritually. There is a habit and a pattern to what is accepted and expected, and if the pattern is not followed and the child remains sick or dies, then the one who made the decision to not first consult the local healer and mullah will be blamed.

Working through it in this manner helped me to better understand the complex situations I was dealing with, but of course did not change the sad reality for little Sitara or the reality for many other children like her. In a country where one in four children will die by the age of five years, it’s easy to get the impression that a child’s life is viewed as of very little worth. But I have seen the agony as a father pleads for some action
to be taken to save his precious son or daughter, and the pain behind the fatalism of parents accepting the loss of yet another precious life. And all I can hold on to in those situations is the hope of a Father who sees when even one sparrow falls, and who will not forget these little ones, or those who mourn them.

Kelly is a Kiwi Partner and a nurse, who has been serving in Central Asia for six years.

/작성자:

Healthcare for the poorest of the poor

Medical / Health

Poor people cannot usually afford to pay for skilled medical care, but a Health and Development NGO in South Asia is challenging that norm by finding ways to make healthcare accessible even to the poorest of the poor.

From humble beginnings as a TB clinic over 30 years ago, it has grown to include a 150-bed hospital and 23 community health care centres, and directly impacts over three quarters of a million people within its community. Despite its impressive growth, the organisation still retains its original mission to serve God through serving the poor and underprivileged, particularly women and children.

The hospital receives people sent from its organisation’s community target areas as well as those who arrive off the street. In the target areas, trained paramedical staff provide basic medical care from community health care centres, and refer patients with more complicated conditions to the hospital. Volunteer village health workers give preventive health education, pregnancy care, supply simple medications and report back basic statistics.

Patients admitted to hospital are expected to pay what they can afford, but if they are unable to cover the full bill they are assessed by a team, which decides on a reasonable payment. Approximately two-thirds of all patients receive assistance in this manner. However, for those patients who have no resources at all (about one in every five people), the bill is completely cancelled. All patients receive the same high standard of care, regardless of their financial situation.

Common medical problems in adults include infectious diseases (including TB and tropical diseases), surgical problems, chronic conditions (such as diabetes), and pregnancy and childbirth complications. As in similar countries, children are mainly ill with gastroenteritis, pneumonia and/ or malnutrition. Most babies are born at home, without trained help, and otherwise well newborns die of cold or infection. Many women die in labour, and others suffer medical problems as a result of prolonged obstructed labour.

Pregnancy advice and care is provided by the community health care centres, many of which are set up to enable expectant mothers to give birth in a safe environment: in 2007 alone, 1320 births were recorded at the health care centres. Over the 25 years that the hospital and community arms have worked together, pregnancy-related and childhood deaths have decreased in the community areas, compared both with when they started, and with surrounding areas not served by the NGO.

While the NGO strives to be sensitive to the cultures and religious beliefs of the various ethnic groups in their area, their vision is to see people living as God intended, in spiritually, physically, socioeconomically and emotionally healthy communities. Even though about 50% of the staff and 90% of the patients are not yet followers of Jesus, all are encouraged to care for the people in their community on the basis of scriptural values and the example of Jesus Christ, who came so that all – even the poorest of the poor – might have abundant life.

The author is a doctor from NZ, and has been based in South Asia since 1998.

Roshida married when she was about 12 years old, and her first pregnancy followed fairly quickly. The baby was lying across her womb rather than head down, and when she went into labour the baby’s arm came out first, and the baby died. When her second baby also died in childbirth, the prolonged labour caused an obstetric fistula – she became constantly wet and smelly and people could not bear to be close to her. She was also regarded as spiritually unclean, so was unable to pray or participate in worship.

When her husband divorced her Roshida returned to live with her parents, but they could not cope with the constant smell. She had to move into a separate hut, similar to a cow shed, and was unable to work in any job that required proximity to other people.

After suffering for about eight years, she came to our organisation for help. Her fistula was easily repaired, and 14 days later she was dry. Her condition had brought deep shame to her, so before she left the hospital, our chaplains prayed with her, for Jesus to cover her shame and make her whole again.

Three months later she returned to the clinic a different woman. She was now earning money and playing an active role in her family and community. When we asked her if she’d be willing to speak at the opening ceremony for the hospital fistula unit, her response was, “Why not? People need to know!” And so the woman who had been too embarrassed to show her face on the ward told her story in front of 100 people, including local dignitaries and journalists. Not only had she regained her physical health but her self-esteem had blossomed – she was healed in the full sense of the word.

Noor Jahan was in labour for four days with her second child before suffering a double tragedy – not only was the baby stillborn, but the prolonged labour had caused an obstetric fistula.

“Nobody liked me after that,” explained Noor Jahan, “not even my mother or my husband. I was very neglected. My husband married again and separated from me without divorcing me.”

She was discovered by one of the village health workers who had been to a seminar on fistulas. When initially approached about coming to the hospital for surgery she refused: “I would rather die than have other people know.” But after she and her husband (who had already spent a lot of money on previous failed attempts at treatment) had further discussions with hospital staff, she decided to have the surgery.

“After being cured I got a new life. Now I am with my family and my husband. My husband loves me very much after my successful operation. Now my neighbours and the villagers like me very much. I am grateful to God and to the hospital.”

She now tells all her neighbours about the dangers of early marriage, and encourages all the pregnant mothers in the village to go for antenatal care. She has become an advocate for women in her own community.

A partner with IS England & Wales (but with a strong Kiwi connection), the author is a doctor who spent 16 years serving in South Asia.

/작성자:

Healthcare for the poorest of the poor

Medical / Health

Poor people cannot usually afford to pay for skilled medical care, but a Health and Development NGO in South Asia is challenging that norm by finding ways to make healthcare accessible even to the poorest of the poor.

From humble beginnings as a TB clinic over 30 years ago, it has grown to include a 150-bed hospital and 23 community health care centres, and directly impacts over three quarters of a million people within its community. Despite its impressive growth, the organisation still retains its original mission to serve God through serving the poor and underprivileged, particularly women and children.

The hospital receives people sent from its organisation’s community target areas as well as those who arrive off the street. In the target areas, trained paramedical staff provide basic medical care from community health care centres, and refer patients with more complicated conditions to the hospital. Volunteer village health workers give preventive health education, pregnancy care, supply simple medications and report back basic statistics.

Patients admitted to hospital are expected to pay what they can afford, but if they are unable to cover the full bill they are assessed by a team, which decides on a reasonable payment. Approximately two-thirds of all patients receive assistance in this manner. However, for those patients who have no resources at all (about one in every five people), the bill is completely cancelled. All patients receive the same high standard of care, regardless of their financial situation.

Common medical problems in adults include infectious diseases (including TB and tropical diseases), surgical problems, chronic conditions (such as diabetes), and pregnancy and childbirth complications. As in similar countries, children are mainly ill with gastroenteritis, pneumonia and/ or malnutrition. Most babies are born at home, without trained help, and otherwise well newborns die of cold or infection. Many women die in labour, and others suffer medical problems as a result of prolonged obstructed labour.

Pregnancy advice and care is provided by the community health care centres, many of which are set up to enable expectant mothers to give birth in a safe environment: in 2007 alone, 1320 births were recorded at the health care centres. Over the 25 years that the hospital and community arms have worked together, pregnancy-related and childhood deaths have decreased in the community areas, compared both with when they started, and with surrounding areas not served by the NGO.

While the NGO strives to be sensitive to the cultures and religious beliefs of the various ethnic groups in their area, their vision is to see people living as God intended, in spiritually, physically, socioeconomically and emotionally healthy communities. Even though about 50% of the staff and 90% of the patients are not yet followers of Jesus, all are encouraged to care for the people in their community on the basis of scriptural values and the example of Jesus Christ, who came so that all – even the poorest of the poor – might have abundant life.

The author is a doctor from NZ, and has been based in South Asia since 1998.

Roshida married when she was about 12 years old, and her first pregnancy followed fairly quickly. The baby was lying across her womb rather than head down, and when she went into labour the baby’s arm came out first, and the baby died. When her second baby also died in childbirth, the prolonged labour caused an obstetric fistula – she became constantly wet and smelly and people could not bear to be close to her. She was also regarded as spiritually unclean, so was unable to pray or participate in worship.

When her husband divorced her Roshida returned to live with her parents, but they could not cope with the constant smell. She had to move into a separate hut, similar to a cow shed, and was unable to work in any job that required proximity to other people.

After suffering for about eight years, she came to our organisation for help. Her fistula was easily repaired, and 14 days later she was dry. Her condition had brought deep shame to her, so before she left the hospital, our chaplains prayed with her, for Jesus to cover her shame and make her whole again.

Three months later she returned to the clinic a different woman. She was now earning money and playing an active role in her family and community. When we asked her if she’d be willing to speak at the opening ceremony for the hospital fistula unit, her response was, “Why not? People need to know!” And so the woman who had been too embarrassed to show her face on the ward told her story in front of 100 people, including local dignitaries and journalists. Not only had she regained her physical health but her self-esteem had blossomed – she was healed in the full sense of the word.

Noor Jahan was in labour for four days with her second child before suffering a double tragedy – not only was the baby stillborn, but the prolonged labour had caused an obstetric fistula.

“Nobody liked me after that,” explained Noor Jahan, “not even my mother or my husband. I was very neglected. My husband married again and separated from me without divorcing me.”

She was discovered by one of the village health workers who had been to a seminar on fistulas. When initially approached about coming to the hospital for surgery she refused: “I would rather die than have other people know.” But after she and her husband (who had already spent a lot of money on previous failed attempts at treatment) had further discussions with hospital staff, she decided to have the surgery.

“After being cured I got a new life. Now I am with my family and my husband. My husband loves me very much after my successful operation. Now my neighbours and the villagers like me very much. I am grateful to God and to the hospital.”

She now tells all her neighbours about the dangers of early marriage, and encourages all the pregnant mothers in the village to go for antenatal care. She has become an advocate for women in her own community.

A partner with IS England & Wales (but with a strong Kiwi connection), the author is a doctor who spent 16 years serving in South Asia.

/작성자:

Healthcare for the poorest of the poor

Medical / Health

Poor people cannot usually afford to pay for skilled medical care, but a Health and Development NGO in South Asia is challenging that norm by finding ways to make healthcare accessible even to the poorest of the poor.

From humble beginnings as a TB clinic over 30 years ago, it has grown to include a 150-bed hospital and 23 community health care centres, and directly impacts over three quarters of a million people within its community. Despite its impressive growth, the organisation still retains its original mission to serve God through serving the poor and underprivileged, particularly women and children.

The hospital receives people sent from its organisation’s community target areas as well as those who arrive off the street. In the target areas, trained paramedical staff provide basic medical care from community health care centres, and refer patients with more complicated conditions to the hospital. Volunteer village health workers give preventive health education, pregnancy care, supply simple medications and report back basic statistics.

Patients admitted to hospital are expected to pay what they can afford, but if they are unable to cover the full bill they are assessed by a team, which decides on a reasonable payment. Approximately two-thirds of all patients receive assistance in this manner. However, for those patients who have no resources at all (about one in every five people), the bill is completely cancelled. All patients receive the same high standard of care, regardless of their financial situation.

Common medical problems in adults include infectious diseases (including TB and tropical diseases), surgical problems, chronic conditions (such as diabetes), and pregnancy and childbirth complications. As in similar countries, children are mainly ill with gastroenteritis, pneumonia and/ or malnutrition. Most babies are born at home, without trained help, and otherwise well newborns die of cold or infection. Many women die in labour, and others suffer medical problems as a result of prolonged obstructed labour.

Pregnancy advice and care is provided by the community health care centres, many of which are set up to enable expectant mothers to give birth in a safe environment: in 2007 alone, 1320 births were recorded at the health care centres. Over the 25 years that the hospital and community arms have worked together, pregnancy-related and childhood deaths have decreased in the community areas, compared both with when they started, and with surrounding areas not served by the NGO.

While the NGO strives to be sensitive to the cultures and religious beliefs of the various ethnic groups in their area, their vision is to see people living as God intended, in spiritually, physically, socioeconomically and emotionally healthy communities. Even though about 50% of the staff and 90% of the patients are not yet followers of Jesus, all are encouraged to care for the people in their community on the basis of scriptural values and the example of Jesus Christ, who came so that all – even the poorest of the poor – might have abundant life.

The author is a doctor from NZ, and has been based in South Asia since 1998.

Roshida married when she was about 12 years old, and her first pregnancy followed fairly quickly. The baby was lying across her womb rather than head down, and when she went into labour the baby’s arm came out first, and the baby died. When her second baby also died in childbirth, the prolonged labour caused an obstetric fistula – she became constantly wet and smelly and people could not bear to be close to her. She was also regarded as spiritually unclean, so was unable to pray or participate in worship.

When her husband divorced her Roshida returned to live with her parents, but they could not cope with the constant smell. She had to move into a separate hut, similar to a cow shed, and was unable to work in any job that required proximity to other people.

After suffering for about eight years, she came to our organisation for help. Her fistula was easily repaired, and 14 days later she was dry. Her condition had brought deep shame to her, so before she left the hospital, our chaplains prayed with her, for Jesus to cover her shame and make her whole again.

Three months later she returned to the clinic a different woman. She was now earning money and playing an active role in her family and community. When we asked her if she’d be willing to speak at the opening ceremony for the hospital fistula unit, her response was, “Why not? People need to know!” And so the woman who had been too embarrassed to show her face on the ward told her story in front of 100 people, including local dignitaries and journalists. Not only had she regained her physical health but her self-esteem had blossomed – she was healed in the full sense of the word.

Noor Jahan was in labour for four days with her second child before suffering a double tragedy – not only was the baby stillborn, but the prolonged labour had caused an obstetric fistula.

“Nobody liked me after that,” explained Noor Jahan, “not even my mother or my husband. I was very neglected. My husband married again and separated from me without divorcing me.”

She was discovered by one of the village health workers who had been to a seminar on fistulas. When initially approached about coming to the hospital for surgery she refused: “I would rather die than have other people know.” But after she and her husband (who had already spent a lot of money on previous failed attempts at treatment) had further discussions with hospital staff, she decided to have the surgery.

“After being cured I got a new life. Now I am with my family and my husband. My husband loves me very much after my successful operation. Now my neighbours and the villagers like me very much. I am grateful to God and to the hospital.”

She now tells all her neighbours about the dangers of early marriage, and encourages all the pregnant mothers in the village to go for antenatal care. She has become an advocate for women in her own community.

A partner with IS England & Wales (but with a strong Kiwi connection), the author is a doctor who spent 16 years serving in South Asia.

/작성자:

Buphal’s Story

Medical / Health

It started six months ago when a mother brought a very thin and unresponsive child to our new nutrition rehabilitation centre. He was 4 years old at the time and only weighed 10 kg, when a normal Nepali 4 year old should tip the scales at about 14kg. His name is Buphal. Buphal is the only son of a woman whose husband left her a few years ago. She has tried to do the best she can by carrying loads of rock and other building materials for a living, but caring for her son has not been an easy job. After all, Buphal is not your average child. Since the beginning of his life he has had special needs. He has a disease called neurofibramatosis which causes neurological problems and some developmental delays, so his mother has no one to support her in a country where there are precious few programs to help developmentally delayed children.

When he first came to the nutrition centre after a brief stay at our mission hospital he did not interact much with our staff. He was severely malnourished and, after only two days with us, developed signs of pneumonia. I sent him back to the hospital for treatment but his mother took him home and we thought that he must have died. Thankfully I was wrong. A few months later he was back at our hospital suffering from severe vomiting and after a few days was readmitted to the nutrition unit. This time he responded to the love, concern, and food that we gave him. It was an amazing thing to see him blossom into an alert young boy. He quickly became one of our favourites because of his kind wide smile and riveting eyes, and as he put on weight he became more and more verbal and interactive.

Even though his mother is not a believer, Buphal loves our Lord. His grandmother attends our church and has had a great influence upon him. Every Saturday before I go to church I always go to the centre to say hello to staff and the clients. He would often be telling his mum to hurry up because he needed to go and pray. It was very apparent that he believed in praying to God because he would grab anyone passing by around mealtime and say “We need to thank God for the food”. This usually happened several times each meal!

As Buphal left our centre the second time he smiled and joked with us as he walked away. We were all amazed at what a little love and food could do. About a month later his grandmother came to our home one evening. She said that I needed to come to her house to visit Buphal. He keeps on asking her when he was going to see me again. He had not been eating well for a few days and she was obviously concerned. I gave her a few eggs and some fruit as well as a 2 rupee coin (Buphal was famous for collecting coins from the pockets of any visitors at the centre).

A few weeks ago he was readmitted to the hospital. He had had some swelling in his face for a few days and woke up at 4am one morning to tell his mum that they needed to go to the church to pray. Thirty minutes later he was unconscious. When he finally arrived at the hospital he was in cardio respiratory arrest and needed CPR. Amazingly, he survived. I visited Buphal’s bed almost every day for two weeks. Each time I go he has been sleeping. His Mom said that he wakes up to eat, says a few simple words, eats a little, and then goes back to sleep. He did have a dental abscess that may have triggered the whole incident. The tooth is now gone but the results of the lack of oxygen to his brain are evident.

Last week at our monthly section meeting (at work) we read the gospel account of the death and resurrection of Jesus with my staff. I then shared the news of Buphal’s condition and began to cry. I think my staff were a little shocked. That’s fine with me. I shared that Buphal knows that he is going to go to heaven and that whether he lives or dies he is in the hands of God. When we went into the time of prayer two other staff asked for prayer about other needs in their lives. I was greatly blessed since these staff are not believers. We were praying to the God that Buphal believed in. He is the God of a little child, the creator and sustainer of all we see and don’t see. Some of my staff have realised that there is power in our God, a power that can only be accessed through faith in Jesus. What a blessing this was for me to see. To think that this opportunity all came from a relationship with a little child!

Yet, the story does not end there. On Easter Sunday we had a special time of prayer for two people at our church. One of the two was Buphal. The next day his grandmother told me that he was now coherent, talkative, again bugging his mum to pray, and seemingly recovered from the event. I had to see this for myself but Buphal’s father, who has been absent for two years, magically returned. The sad news is that Buphal and his mum left for the father’s village the next day and then less than a week later they all went to Mumbai for work. I have yet to see Buphal but I know that whether I see him on this side of heaven or in the presence of God I will look on the face of a child who truly loves and believes in the risen Lord of all creation.

/작성자:

Buphals Story

Medical / Health

It started six months ago when a mother brought a very thin and unresponsive child to our new nutrition rehabilitation centre. He was 4 years old at the time and only weighed 10 kg, when a normal Nepali 4 year old should tip the scales at about 14kg. His name is Buphal. Buphal is the only son of a woman whose husband left her a few years ago. She has tried to do the best she can by carrying loads of rock and other building materials for a living, but caring for her son has not been an easy job. After all, Buphal is not your average child. Since the beginning of his life he has had special needs. He has a disease called neurofibramatosis which causes neurological problems and some developmental delays, so his mother has no one to support her in a country where there are precious few programs to help developmentally delayed children.

When he first came to the nutrition centre after a brief stay at our mission hospital he did not interact much with our staff. He was severely malnourished and, after only two days with us, developed signs of pneumonia. I sent him back to the hospital for treatment but his mother took him home and we thought that he must have died. Thankfully I was wrong. A few months later he was back at our hospital suffering from severe vomiting and after a few days was readmitted to the nutrition unit. This time he responded to the love, concern, and food that we gave him. It was an amazing thing to see him blossom into an alert young boy. He quickly became one of our favourites because of his kind wide smile and riveting eyes, and as he put on weight he became more and more verbal and interactive.

Even though his mother is not a believer, Buphal loves our Lord. His grandmother attends our church and has had a great influence upon him. Every Saturday before I go to church I always go to the centre to say hello to staff and the clients. He would often be telling his mum to hurry up because he needed to go and pray. It was very apparent that he believed in praying to God because he would grab anyone passing by around mealtime and say “We need to thank God for the food”. This usually happened several times each meal!

As Buphal left our centre the second time he smiled and joked with us as he walked away. We were all amazed at what a little love and food could do. About a month later his grandmother came to our home one evening. She said that I needed to come to her house to visit Buphal. He keeps on asking her when he was going to see me again. He had not been eating well for a few days and she was obviously concerned. I gave her a few eggs and some fruit as well as a 2 rupee coin (Buphal was famous for collecting coins from the pockets of any visitors at the centre).

A few weeks ago he was readmitted to the hospital. He had had some swelling in his face for a few days and woke up at 4am one morning to tell his mum that they needed to go to the church to pray. Thirty minutes later he was unconscious. When he finally arrived at the hospital he was in cardio respiratory arrest and needed CPR. Amazingly, he survived. I visited Buphal’s bed almost every day for two weeks. Each time I go he has been sleeping. His Mom said that he wakes up to eat, says a few simple words, eats a little, and then goes back to sleep. He did have a dental abscess that may have triggered the whole incident. The tooth is now gone but the results of the lack of oxygen to his brain are evident.

Last week at our monthly section meeting (at work) we read the gospel account of the death and resurrection of Jesus with my staff. I then shared the news of Buphal’s condition and began to cry. I think my staff were a little shocked. That’s fine with me. I shared that Buphal knows that he is going to go to heaven and that whether he lives or dies he is in the hands of God. When we went into the time of prayer two other staff asked for prayer about other needs in their lives. I was greatly blessed since these staff are not believers. We were praying to the God that Buphal believed in. He is the God of a little child, the creator and sustainer of all we see and don’t see. Some of my staff have realised that there is power in our God, a power that can only be accessed through faith in Jesus. What a blessing this was for me to see. To think that this opportunity all came from a relationship with a little child!

Yet, the story does not end there. On Easter Sunday we had a special time of prayer for two people at our church. One of the two was Buphal. The next day his grandmother told me that he was now coherent, talkative, again bugging his mum to pray, and seemingly recovered from the event. I had to see this for myself but Buphal’s father, who has been absent for two years, magically returned. The sad news is that Buphal and his mum left for the father’s village the next day and then less than a week later they all went to Mumbai for work. I have yet to see Buphal but I know that whether I see him on this side of heaven or in the presence of God I will look on the face of a child who truly loves and believes in the risen Lord of all creation.

/작성자:

Buphal’s Story

Medical / Health

It started six months ago when a mother brought a very thin and unresponsive child to our new nutrition rehabilitation centre. He was 4 years old at the time and only weighed 10 kg, when a normal Nepali 4 year old should tip the scales at about 14kg. His name is Buphal. Buphal is the only son of a woman whose husband left her a few years ago. She has tried to do the best she can by carrying loads of rock and other building materials for a living, but caring for her son has not been an easy job. After all, Buphal is not your average child. Since the beginning of his life he has had special needs. He has a disease called neurofibramatosis which causes neurological problems and some developmental delays, so his mother has no one to support her in a country where there are precious few programs to help developmentally delayed children.

When he first came to the nutrition centre after a brief stay at our mission hospital he did not interact much with our staff. He was severely malnourished and, after only two days with us, developed signs of pneumonia. I sent him back to the hospital for treatment but his mother took him home and we thought that he must have died. Thankfully I was wrong. A few months later he was back at our hospital suffering from severe vomiting and after a few days was readmitted to the nutrition unit. This time he responded to the love, concern, and food that we gave him. It was an amazing thing to see him blossom into an alert young boy. He quickly became one of our favourites because of his kind wide smile and riveting eyes, and as he put on weight he became more and more verbal and interactive.

Even though his mother is not a believer, Buphal loves our Lord. His grandmother attends our church and has had a great influence upon him. Every Saturday before I go to church I always go to the centre to say hello to staff and the clients. He would often be telling his mum to hurry up because he needed to go and pray. It was very apparent that he believed in praying to God because he would grab anyone passing by around mealtime and say “We need to thank God for the food”. This usually happened several times each meal!

As Buphal left our centre the second time he smiled and joked with us as he walked away. We were all amazed at what a little love and food could do. About a month later his grandmother came to our home one evening. She said that I needed to come to her house to visit Buphal. He keeps on asking her when he was going to see me again. He had not been eating well for a few days and she was obviously concerned. I gave her a few eggs and some fruit as well as a 2 rupee coin (Buphal was famous for collecting coins from the pockets of any visitors at the centre).

A few weeks ago he was readmitted to the hospital. He had had some swelling in his face for a few days and woke up at 4am one morning to tell his mum that they needed to go to the church to pray. Thirty minutes later he was unconscious. When he finally arrived at the hospital he was in cardio respiratory arrest and needed CPR. Amazingly, he survived. I visited Buphal’s bed almost every day for two weeks. Each time I go he has been sleeping. His Mom said that he wakes up to eat, says a few simple words, eats a little, and then goes back to sleep. He did have a dental abscess that may have triggered the whole incident. The tooth is now gone but the results of the lack of oxygen to his brain are evident.

Last week at our monthly section meeting (at work) we read the gospel account of the death and resurrection of Jesus with my staff. I then shared the news of Buphal’s condition and began to cry. I think my staff were a little shocked. That’s fine with me. I shared that Buphal knows that he is going to go to heaven and that whether he lives or dies he is in the hands of God. When we went into the time of prayer two other staff asked for prayer about other needs in their lives. I was greatly blessed since these staff are not believers. We were praying to the God that Buphal believed in. He is the God of a little child, the creator and sustainer of all we see and don’t see. Some of my staff have realised that there is power in our God, a power that can only be accessed through faith in Jesus. What a blessing this was for me to see. To think that this opportunity all came from a relationship with a little child!

Yet, the story does not end there. On Easter Sunday we had a special time of prayer for two people at our church. One of the two was Buphal. The next day his grandmother told me that he was now coherent, talkative, again bugging his mum to pray, and seemingly recovered from the event. I had to see this for myself but Buphal’s father, who has been absent for two years, magically returned. The sad news is that Buphal and his mum left for the father’s village the next day and then less than a week later they all went to Mumbai for work. I have yet to see Buphal but I know that whether I see him on this side of heaven or in the presence of God I will look on the face of a child who truly loves and believes in the risen Lord of all creation.

/작성자:

Buphal’s Story

Medical / Health

It started six months ago when a mother brought a very thin and unresponsive child to our new nutrition rehabilitation centre. He was 4 years old at the time and only weighed 10 kg, when a normal Nepali 4 year old should tip the scales at about 14kg. His name is Buphal. Buphal is the only son of a woman whose husband left her a few years ago. She has tried to do the best she can by carrying loads of rock and other building materials for a living, but caring for her son has not been an easy job. After all, Buphal is not your average child. Since the beginning of his life he has had special needs. He has a disease called neurofibramatosis which causes neurological problems and some developmental delays, so his mother has no one to support her in a country where there are precious few programs to help developmentally delayed children.

When he first came to the nutrition centre after a brief stay at our mission hospital he did not interact much with our staff. He was severely malnourished and, after only two days with us, developed signs of pneumonia. I sent him back to the hospital for treatment but his mother took him home and we thought that he must have died. Thankfully I was wrong. A few months later he was back at our hospital suffering from severe vomiting and after a few days was readmitted to the nutrition unit. This time he responded to the love, concern, and food that we gave him. It was an amazing thing to see him blossom into an alert young boy. He quickly became one of our favourites because of his kind wide smile and riveting eyes, and as he put on weight he became more and more verbal and interactive.

Even though his mother is not a believer, Buphal loves our Lord. His grandmother attends our church and has had a great influence upon him. Every Saturday before I go to church I always go to the centre to say hello to staff and the clients. He would often be telling his mum to hurry up because he needed to go and pray. It was very apparent that he believed in praying to God because he would grab anyone passing by around mealtime and say “We need to thank God for the food”. This usually happened several times each meal!

As Buphal left our centre the second time he smiled and joked with us as he walked away. We were all amazed at what a little love and food could do. About a month later his grandmother came to our home one evening. She said that I needed to come to her house to visit Buphal. He keeps on asking her when he was going to see me again. He had not been eating well for a few days and she was obviously concerned. I gave her a few eggs and some fruit as well as a 2 rupee coin (Buphal was famous for collecting coins from the pockets of any visitors at the centre).

A few weeks ago he was readmitted to the hospital. He had had some swelling in his face for a few days and woke up at 4am one morning to tell his mum that they needed to go to the church to pray. Thirty minutes later he was unconscious. When he finally arrived at the hospital he was in cardio respiratory arrest and needed CPR. Amazingly, he survived. I visited Buphal’s bed almost every day for two weeks. Each time I go he has been sleeping. His Mom said that he wakes up to eat, says a few simple words, eats a little, and then goes back to sleep. He did have a dental abscess that may have triggered the whole incident. The tooth is now gone but the results of the lack of oxygen to his brain are evident.

Last week at our monthly section meeting (at work) we read the gospel account of the death and resurrection of Jesus with my staff. I then shared the news of Buphal’s condition and began to cry. I think my staff were a little shocked. That’s fine with me. I shared that Buphal knows that he is going to go to heaven and that whether he lives or dies he is in the hands of God. When we went into the time of prayer two other staff asked for prayer about other needs in their lives. I was greatly blessed since these staff are not believers. We were praying to the God that Buphal believed in. He is the God of a little child, the creator and sustainer of all we see and don’t see. Some of my staff have realised that there is power in our God, a power that can only be accessed through faith in Jesus. What a blessing this was for me to see. To think that this opportunity all came from a relationship with a little child!

Yet, the story does not end there. On Easter Sunday we had a special time of prayer for two people at our church. One of the two was Buphal. The next day his grandmother told me that he was now coherent, talkative, again bugging his mum to pray, and seemingly recovered from the event. I had to see this for myself but Buphal’s father, who has been absent for two years, magically returned. The sad news is that Buphal and his mum left for the father’s village the next day and then less than a week later they all went to Mumbai for work. I have yet to see Buphal but I know that whether I see him on this side of heaven or in the presence of God I will look on the face of a child who truly loves and believes in the risen Lord of all creation.

/작성자: