A Just Walk (run, hike, etc…)

"…to the Rock that is higher…"

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Super-conference and a birthday marathon

Not just another conference…

It’s hard to believe that we’re well into March already! February was a very full but fabulous month as it was the every-two-year Continuing Medical Education (CME) meeting for health professionals working in cross-cultural health settings across Asia.

The conference is designed for North American (because we tend to have stricter requirements) health professionals who need valuable CME to maintain their practice license. It is of course a full schedule of medical lectures (all optional), but it is much more than straight medical lectures. Workshops in reading ECGs, “ultrasound for dummies”, and use of other techniques and modalities to help those of us working in areas where there is no other specialty consult service (such as when I was working at Kwai River Christian Hospital). The faculty who come take their own time and spend their own money to come and teach us. THANK YOU!

However, it is even MORE than a medical conference! Every two years I get to spend a couple of weeks with friends from all over the world learning, worshiping, crying, laughing, and enjoying each other. These people are truly my peers and it is so refreshing to come together again. Many of us will drag ourselves in haggard and weary – barely hanging on until we can get to Chiang Mai (location of the meeting since 2001). The week is tiring enough, but it is a break from our normal schedules and routines. Although I left quite exhausted – having maxed out my capacity for people interaction several times over – I was also thoroughly refreshed.

Therefore, I want to encourage all of you who support cross-cultural medical workers to support them financially to attend meetings such as this one. It is important professionally, of course. But I know it is also a lifeline for many of us and it is a component of “member care” that enables us to go back and keep going in our work abroad. It is a break for health care professionals AND their families (many are 2-profession families). Another thing to consider in support of your worker is to come and serve as a child care worker at similar conferences. Not a “glamorous” short term mission, but an absolutely essential one! If you are a member of CMDA (Christian Medical Dental Association), consider contributing towards this very valuable medical missions endeavor – your sponsorship helps keep the costs down for us.


birthday marathon start 7 March 2013My birthday was last week and of course I had to celebrate with a special run! The marathon distance is basically 42km (26.2 miles) and so I had a birthday marathon to celebrate 42 years! Three running buddies showed up for coffee before heading out at the 6am start time. Two ran the first 10km loop, but then had to get off to work. The third gutted it out to the last. He is fit, but I had the special birthday adrenaline and just could not slow down… until he asked if we could walk. <WALK!?!> To his credit, we actually went 44.6km because I found a new trail and didn’t want to turn back so soon. The only thing pulling me back was that I had another (non-running) friend coming to my house to make pancakes for my post-run treat! Besides, I had to be back, cleaned up and fed before my scheduled massage! That evening I spent with another couple of friends at my favorite live music hangout place.


It is just a few weeks until Easter. I don’t know what traditions you follow for the Lenten season – I actually never really heard of Lent, or thought it was something for me until I was older – but I like to read one of two books to be mindful of the season. This year it is Henri Nouwen’s “Show Me The Way” that takes one through every day of Lent. Nouwen has always been a sort of pastor to me. I know that you will also be enriched from his writing as well. What kinds of practices do you follow for the season, if any?


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A Week in Nicaragua (S.S.D.C.)

I spent last week in Nicaragua with a group of health professionals of to provide some medical relief to sexually exploited women and girls. Many of these children and young women had actually been rescued from sexual slavery – some as young as six years old. Others had been prostituted for up to 10 years before finally given the opportunity to leave.

This “opportunity” is in the form of a guy named Oscar. Oscar is a middle-aged Nicaraguan evangelist with indefatigable passion to serve, protect and lead to freedom prostituted women and girls. Oscar’s own story provides a heartbreaking, yet divinely orchestrated back story for his amazing ministry today, but you really need to hear it directly from him. Day and night he tirelessly visits women in the brothels, not only telling them, but demonstrating to them the good news of God’s love. When he learns of young girls who are locked up he investigates and then (working with certain authorities) rescues them. When the girls run away from the shelter or are taken away by a parent or guardian, he tracks them down and tries to get them back.

Prostitution of women over 18 is legal in Nicaragua, but many were trafficked as girls before that “mature” age. Many of the girls were sold by their mothers, fathers, or other family members in a generational cycle of violence. Some of the stories are unimaginable. Unfortunately there are also many boys who are sexually exploited as well, but to date there is no place in Nicaragua for them to go.

Our group, which was sponsored by CMDA’s Global Health Outreach (GHO) was made of several OB/GYNs, family medicine, and internal medicine docs and yours truly was the lone pediatrician. We also had two American dentists (joined by a Nicaraguan dentist), two pharmacists, a medical student (3rd year), and several non-medical “logistics” people. The latter turned out to be every bit as valuable as the providers – something like the body of Christ in 1 Corinthians 12 comes to mind.

We saw approximately 650 patients, with pediatric patients numbering about 300 patients! Of course I had help from the medical student and the family medicine docs, and it was a blast to see all those kids and get back to seeing some cute kids. Oscar had spent several days and nights promoting the clinic in the brothels, and from the number of patients, he must have canvassed every one!

House of Hope Nicaragua (HoH) was our host organization with over 50 residents on campus, from unaccompanied minors to families of women and her children and/or grandchildren. They learn basic life skills in order to   Income-generating projects include making greeting cards and jewelry, and sewing projects.

Our goal was to serve the medical needs of the women and girls in the HoH shelter as well as provide a medical outreach opportunity to women and girls in the brothels of Managua. Our long term goal is to establish continuity of relationships and health care to the sexually exploited of Managua as GHO is committed to sending a team every six months. If you are interested in being a part of this, let me know.

Many women living outside House of Hope, regardless of whether they are still being prostituted or not, attend small groups for fellowship and Bible studies, led by Oscar and his wife.

I learned quite a bit in Nicaragua, holding a focus group and other interviews to learn more about their culture, the country, and attitudes towards health and disease.

The stories of heartbreak, evil, shame, redemption, renewal and glory are tremendous. Christ is very much at work at House of Hope, but so is the Evil One. We all know who will win in the end, but I was blessed to be a small part of the work going on there until Kingdom come.

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Report-y Post: West Coast Tour

Yesterday  I traveled from Irvine, CA to Wisconsin. I arrived in Portland, OR 19 April and so have spent the last 33 days on Pacific Central Time. I loved every day of it! This is a report-y kind of post highlighting some of what I’ve been up to, which has included a little bit of everything.

In Portland, I met with Brian Willis, my Global Health Promise colleague, in person for the first time in 18 months. Needless to say we had a lot to discuss! I also had an opportunity to spend some time at Our Mother’s House, meeting the wonderful volunteers who faithfully help out there, as well as meeting some of the women who participate in the OMH activities. I was invited by the Oregon School of Health Sciences to give a talk on health and human trafficking. Furthermore, I was able to spend some time with a colleague as we initiated work on an upcoming project – stay tuned for more on that! Of course, my good friends saw to it that I got a good tour around Portland, as well as a hike in the Mt. Hood National Forest!

After Portland, I headed to Mount Hermon, CA (near Santa Cruz & San Jose) to participate in the Christian Medical and Dental Associations (CMDA) National Meeting. Not only was I was asked to speak on trafficking in persons; I was also invited to participate in the House of Representatives meeting as the Cross-cultural Partner Representative. It was quite an honor on both accounts. My involvement with the CMDA has been rather tangential – related only to the CMDE meetings they host so that overseas partners can get CME credit at medical meetings in Thailand or Kenya. At the Mt. Hermon meeting, I learned a lot more about this organization with the opportunity to meet more of the core people involved, as well as the up and coming leadership. I can’t help but mention that the Henry Cowell State Park is right across the street, so daily runs among the Redwood Giants was quite a bonus!

I took the train from San Jose to Ventura, CA. It’s a delightful ride and I hope you get the opportunity to do it sometime. I stayed about with some from friends from the Breathe Conference I attended in Switzerland last year – brief but warm stay with extended Breathe family.

Then on to Los Angeles! A place that is ALWAYS good to visit! I spent a lot of time with staff and members of Pacific Crossroads Ch, a local body that knows how to make the most of their visiting partners (they know how to take care of them as well). UCLA students interested in addressing human trafficking invited me to speak on a couple of occasions. One was to a group of medical students during one of their noon meetings. The other was to speak at Mighty Mic UCLA, an annual fund-raising concert put on by undergraduates. I also got to meet with several other people and organizations working against human trafficking – always seeking, always asking, always learning. Of course there was time at the beach, the ballpark,

Me, Stacey, and Rich at a Padres game

the brewpub, and beautiful runs! Catching up with long-time friends, and making many new ones.

Beautiful Half Dome, covered in snow, as seen from my campsite 18 May

Next stop on my way down the coast was Irvine, CA for a time of R &R. My friends Rob and Robin, also extended family from last year’s Breathe Conference, let me hang at their place for a week. But we didn’t exactly sit around. Huge Yosemite Park fans, we drove up for a short but sweet trip to the mountains! Unfortunately, the weather didn’t cooperate with our plans for big hikes, as most of the high climbs (including Yosemite Falls) were closed down for snow and ice! It even snowed in the valley! To make the most of it, I ended up going for a couple of long trail runs around the valley: rain, snow, mud, and raging streams made up for adventure! Someone asked if I was a professional runner! HA! Back in Irvine, a sailing trip on the ocean, a long run at Crystal Cove State park, and some downtime with books and movies made for a fun and relaxing week.

In Wisconsin this week, I’ll be attending the International Christian Alliance on Prostitution (ICAP) Global Conference at Green Lake. I’m looking forward to a time to work (face to face!) with colleagues on several projects, as well as network with new and potential partners.

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On The Road Again

Lately I’ve been traveling (A LOT!) to different parts of China. Just over a week after getting back from Thailand, I spent a few days in a city in central China to visit a project that reaches out to vulnerable women in the entertainment business. I am not at liberty to say where or the name of the organization because security in there is particularly tight. Nearly all of them have been to prison (due to suspicion of their activities as followers) at least once, but they faithfully continue, and what they are doing in the face of adversity is remarkable – and growing! It was such a privilege and an honor to work with a group of people who have sacrificed so much to love the unlovable. I have never have I been asked to risk or sacrifice so much in my work or to defend my faith. Some of the staff had been trafficked themselves and are now reaching out and helping to get others out of slavery. I was able to go over some basics of reproductive health as well as give an overview of some of the common mental health disorders that they see. I also spent quite a bit of time with some of them in one-on-one sessions discussing anything from insomnia, issues in rearing children and child behavior, and other medical issues. Every minute of time there was a blessing. Remember to ask me about it if I get to share with you in person.

Ma Chi and Rachel examine a baby

Less than a week after that trip, I left for a 10-day trip to SE China to help facilitate and develop Pediatric work with a family medicine training program in Macau. Three of us (two pediatricians and a resident) traveled from our program in Shenyang, and one pediatrician came all the way from Texas to participate. The family med doc and one of the residents came from the Hope Macau program. Six women traveled by van to several places in Guangdong province visiting various places that serve abandoned children in China.

a few of the orphans practice CPR on their toys after watching the adult's do their training! (photo credit: Nancy Y.)

Like anything in China, a wide variety of situations exist among these types of places. A couple places we visited were at government child welfare institutions that had various levels of cooperation with foreigners to help in the daily care and education of the children. Other places were foreign-run foster homes that care for children outside of the institution. Our visits involved a combination of evaluating children with acute as well as chronic health needs, teaching the local physicians about the problems we diagnosed, and training the staff and nannies in basic CPR and other techniques in caring for special needs children.

For example, I diagnosed a child with Apert syndrome, and Turner syndrome, and a colleague diagnosed another with Bloom syndrome. We gave an overview of these syndromes, what the doctors need to check for soon, as well as some anticipatory guidance. Every child was reviewed with one the local physicians regarding their specific care – be it a congenital heart defect, Down Syndrome, or one of the many other problems often seen. We also gave some recommendations for general care of all the children, such as hearing screens and dental care. Whether or not they follow up on any of these recommendations is anyone’s guess, but it seems like they were more invested than at other places I’ve visted.

Generally speaking, many of the doctors assigned to child welfare institutions (if any are assigned at all) are not specifically pediatricians (a few are), and learn about the problems of these children through on-the-job training. Some I have encountered are very eager to learn about pediatric medicine, and some are not teachable at all and just want to keep their low-risk government job. A medical problem is a (if not THE MOST) common reason why a child in China is abandoned, therefore equipping physicians in caring for special needs children is a big need here.

in the square oppoite the Macau Cathedral - one of my favorite places to sit and rest a bit in the midst of a busy city

Before the pediatric road trip I spent a couple of days meeting with organizations that outreach to and care for vulnerable women in Macau. The situation for women in the “entertainment business” Macau is quite different than on the mainland – it is a bit more “open” and “less illegal” and the rule is conveniently ambiguous. Also, mainlanders still need to ask permission to travel to Macau and then can stay only two weeks. Therefore, the temporary service people have a very rapid turn-over. They return over and over again, but not always to the same place. However, it is somewhat difficult to explain well in a blog because I still have to be sensitive in reporting on the situation and who is doing something about it. “Conveniently ambiguous” means that the rules can bend far one way or another – in one’s favor or not – so I’m going to err on the side of providing less information here. Suffice to say that because of the different situation there, the girls, and the outreach to them needs to be creative and adaptive.

Since I had last visited, one particular outreach group has started a clinic for the women! It was good  to check in on how things are truly going, encourage the physician and give input in to how best the non-medical people may maximize their impact through health counseling and follow up. I also visited a Sister of the Good Shepherds, an order that is dedicated to serving women in difficulty. As you can guess, this also includes women who have been trafficked in the entertainment business. She was a delight to speak with and since she had been there for over 20 years, I learned quite a bit about life and work there!

Always, the travel is not glamorous, it is not easy, and can be fraught with frustration. However, at the end of a trip, no matter how exhausted I am, I come away with blessings – gifted more than I have given for sure.

potty brigade!

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Developmental Pediatrics

Eliana tells us about her drawing

Every Friday afternoon in the residents’ schedule is what we call “Academic Afternoon” where they gather for some didactic lectures in medicine. The lectures are divided among the faculty. Last week, the pediatricians, Eva, Nancy, and I got together to give the residents a demonstration in developmental pediatrics.

We got several of our friends to lend us their children (including Eva’s own four) for the afternoon which gave us children with the ages from 1 to 8 years old. We went through gross motor, fine motor, speech and language, and social developmental stages, having the kids go through a series of movements, drawing pictures, and telling us about what they drew. We highlighted “red flags”, stressed the benefits of reading, and discussed how to incorporate developmental screening into the clinic visit.

While discussing speech development, I explained the consonants and words that are often first spoken in an English environment. I asked the residents to tell me which words are often spoken first by Chinese babies. One of the residents said “qian” (money). We all had a good laugh, but I’m not sure it was a 100% joke – there is truth in banter!

Since almost all of the residents’ pediatric exposure is with children in orphanages and foster care, and well-child care in China only amounts to getting shots,  they don’t often get to interact with healthy babies, watching them develop over time.

While we were discussing, the kids were allowed to be kids playing, and coloring, doing puzzles, and we encouraged the residents to just practice observing them even as we talked. Getting to teach in creative ways is always a lot of fun!

Eva leading the discussion (note the hospital laundry in the background)


Cambodia Thailand 2011

I’ve just returned back to China and I will attempt here to eek out a blog post that will summarize the trip. Although several blog posts would be better to go through everything there is to tell, I have this tension about not exactly being a professional blogger.

The first part of the trip was to participate in a conference of colleagues working all over China serving in many different ways, doing many different things. One of the cool things about this gathering was that my colleagues hail from many different countries, and our conference is largely bilingual to accommodate the many people from another Asian nation working with us. Unfortunately, I cannot elaborate more on this due to security reasons, but if you want to know more, ask me in person sometime.

roasted spiders at a bus rest stop in rural Cambodia - not exactly on my training diet.

From Northern Thailand I went to Cambodia for ten days in Cambodia to 1) do a health services consultation; 2) to learn about the trafficking situation in general; and 3) assess and explore the needs of health care for the vulnerable and the victims as well as ways in which health professionals could get more involved. I met with many people representing different organizations (such as Chab Dai, World Hope International, Destiny Rescue, International Justice Mission, and Love146, to name a few) working in several different aspects of trafficking in persons from prevention to long-term aftercare. I am grateful for their willingness to spend so much time with me and answer my myriad questions! I learned so much – which would actually take several blog posts to unpack only a bit of it.

One of the main purposes of my visit was to do a health services consultation with Destiny Rescue. In addition to providing long term aftercare to girls and young women, they are also involved in community development as prevention work to combat human trafficking. This group understands the important point that a trafficked person’s vulnerability starts long before they find themselves an actual slave and that the process is often rooted in community and culture.

In consultation I do needs assessments of their projects at their respective sites, speaking with staff in various roles, often in focus group-style meetings. I asked many questions and they were very helpful and forthcoming with their own questions. It is actually quite a lot of fun to sit and share, learning and teaching at the same time. Sometimes I’m asked to do specific medical consultations, or address particular health questions. One thing that I’m now more careful to address is the care of the staff. To be holistic in approach to counter-trafficking efforts means taking good care of oneself and one’s staff.

After the consultation, and some debriefing with the leaders, I give a report of my observations and assessments with suggestions for what interventions could either be augmented or newly started. These may involve simple or complex, short or long term plans, but usually, no matter where I go, it is a beginning of a working relationship.

After Cambodia, I went back to Chiang Mai, Thailand for a CMDA-CMDE meeting. Every year, like-minded doctors (mostly, but not exclusively, American) committed to overseas medical work take their own time off and pay their own way to provide overseas partners such as myself with training to give us not only continuing medical education (CME) credit but equip us to do things we encounter in the field that a western medical education never prepared us to tackle (like dental extractions or tetanus). Field partners are also invited to give lectures in their respective specialties: I gave a talk on human trafficking and my colleague Eva presented on humanitarian crises, with a focus on children.

Nearly two weeks of rich fellowship, medical learning and shop talk, worship, networking, meetings, and of course lots of fun! I look forward to seeing friends here from all over the world that I only get to see every two years at this conference (a sister conference is held the other years in Africa) and I always meet new friends as well. There was also ample face-time with people with whom I collaborate on projects where we normally only get to email and skype with each other, so that was an added bonus.

Os Guinness was our main speaker for the conference – what a blessing it was to hear him speak and expound on ideas of globalization, communication, and the Christian’s role and purpose and way in this 21st Century. Foundational, it truly is no different from a 1st century Christian’s. However, remaining true to Love in this fast-paced, twitter-faced, information-saturated, modern-rated, speed-dated world (my words, not Os’s) of ours requires tools for examining our history and recognizing where we are in the present in order to prepare for the future. To be not conforming, but transforming.

As usual, I have not one photo of me to prove that I have all this work and all these friends around the world like I say I do! One of these days I’ll start remembering!

Now back in Shenyang, I get to continue to process this as well as move on to the new work and upcoming projects! Looking forward to writing more about it!

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A good place to be in February

resting in Queen Sirikit Botannical Gardens - located right across from our resort!

This month I’ve escaped the the sterile frozen climate of NE China to the hot and vibrant environment of Thailand and Cambodia! It is primarily a work trip, but just being warm is wonderful! My legs are freely moving on my runs and my lungs are getting a fresh air wash-out. Ahhh…

Last weekend I was in Chiang Mai Thailand at my agency’s annual conference for all the partners serving in China. It is wonderful to catch up with the work and life of my colleagues, and learn about certain movements and activities which are otherwise not publishable.

Yesterday I arrived in Phenom Penh – greeted at the airport by a gracious and helpful Cambodian who is himself a director of a local NGO! What a wonderful way to begin my stay. Last night I had dinner with some great friends here – John and Deb Coats. I first visited Cambodia 10 years ago and stayed in their bamboo house in a rural village and built wonderful memories. Although we have connected several times over the years, it is wonderful to cross paths once again in their host country.

This morning I have a meeting with a couple who are about as well-connected as possible in the counter-trafficking circles in this country. We have shared interests and goals to take after-care, prevention, research to a higher level in this country and throughout Asia, all in the context of training and building capacity of indigenous peoples everywhere. Later on in the week I’ll be doing some trainings and consulting at Destiny Rescue’s rural after care shelter. I’m looking forward to building on these relationships and develop other collaborative partners in the work here. There is a dire need for better, well-informed health care to meet the deep needs of these traumatized children and young adults.

After this stint in Cambodia, I’m headed back to Chiang Mai to participate in a continuing medical education conference (sponsored by CMDA) for like-minded health professionals serving in Asia. It’s an every two year event that brings hundreds of us from all over together for learning, encouragement, and a bit of fun as well. As far as conferences go, this is the best one I’ve ever attended!

Happy Chinese New Year to everyone – it is the year of the Rabbit!