reflections

written 5/6/12 on the train on the way back from the airport

After 17 hours en route, I arrived back to Lancaster today.  I did my best to say my despedidas (farewells) well as I left.  Before I start a busy month on OB tomorrow, I wanted to try to process some of the rotation today.  

  

Ecuador, at least the parts I experienced, is much better off economically than either the majority of India or Zambia, my two most recent overseas points of comparison.  It shows up in little things, like the fact that having dogs as pets is common (no one can afford to feed a dog regularly where I was in Zambia when their kids come into the hospital with severe malnutrition).  Fashion in Ecuador goes beyond the usual more-dressed-up-than-your-average-American lack of cotton (usual in Latin America in my experience) and tight jeans, reflecting more the fashion mores – the little I know them – of North America and Europe with scarves, boots, and cute handbags.   The life expectancy is high, and I did see some diseases of affluence (e.g. diabetes), even if their management is more difficult (no glucometers, no lancets, etc.)

It makes me wonder if I would be needed there, medically at least.  I respect the doctors who work there, many of whom have given years of their lives to serve far from their culture of origin, families, and same-culture friends.  Their sacrifice to be obedient to God's call on them is not to be ignored or easily dismissed. 

Still, my experience also made me think about the style of missions I want to be part of.  Due in part to the need to be close to the hospital, in part to regulations requiring them to clearly demarcate the HCJB lands, and in part to security concerns, the vast majority of the missionaries from various organizations live together on a fenced in compound behind the hospital with a gate that closes and locks at night.  Most of their kids go to a missionary kid (MK) school where Spanish is taught as a language. 

I’m ambivalent about these things.  When I’m on call at night, I like the security of knowing there’s a locked gate when I walk home at one or two in the morning.  I like the fact that the walk takes me two minutes and not ten (and that would be dangerous for patient care in some situations if I couldn’t get to the hospital quickly enough).  But I don’t like the sectarian feel of living in a separated-off part of town (“Gringolandia,” as the residents called it, and even they didn’t "trespass" there) rather than with the people whom I came to serve.  

Jesus came and tabernacled among us (John 1), walking in our dust, eating our food, suffering our vulnerability in service.  If he is my model, to what extent can and should I avoid the daily complications and risks of life overseas if it lies within my power?  Eating from vendors off the street?  Risking getting a few GI bugs and parasites in order to eat with people in their homes, including vegetables and fruit that weren’t soaked in special cleaning solution?  Risking being a target of robberies or worse if I live among people as someone who is noticeably different?  How would this look with a family?  To what extent could I expose my children – Lord willing – to risks I undertake to serve him and his people?

I’m also ambivalent about the schooling.  Part of me thinks that an MK school right next door to the hospital would be attractive – a quality school where one’s children could attend in their native language without having to be far away (i.e. like the old boarding school model where one’s children were sent off starting at age five and saw their parents in the summers).  But part of me wonders what message it sends the community about my opinion of the quality of their schools, the desire (or lack thereof) for our children to be friends with their children, and the importance of language and culture learning in the nearly effortless, osmotic way that only children can learn them.   

I envision children being such a potential benefit for building relationships and bridges when in a new cultural context and for modeling in a marriage and a family what effects Jesus has on our lives.  What would it mean to do what is best for them and also avoid setting up additional barriers between me and the national people?  This is especially complicated with older children (how different can it be to learn to add and subtract, read and write in another language as long as they use the same letters and numbers? but what if they didn’t?) and when I’m not sure about coming back to the States for the children’s schooling later, meaning they would have to be able to fit back into our educational system and learning in English.

A photo of a painting by famous Ecuadorian painter Guayasamin, who broke expectations by portraying his subjects with the blunter fingers and facial planes of the indigenous people.  Ecuador does still suffer controversy regarding discrimination against its indigenous population.

These questions aside, there are many ways in which working in a place like Hospital Vozandes del Oriente would be much easier and simpler than working in many other places I have been.  Many more lab tests and even imaging studies are available, if not at our hospital then in Quito (e.g. Pap smears, TSH) or in nearby Puyo (e.g. CT scans).  As mentioned in other posts, living and working conditions themselves are relatively easy (e.g. electricity, running water, even hot water, washer/dryer).  I would enjoy working with residents and interns, and I LOVE speaking Spanish regularly.  It certainly is a spiritually open culture where I can speak of God and people generally understand what I’m talking about and are open to hearing it.  But I still don’t know…

Underlying all these questions is the bigger question of calling.  It is not so much a question of a calling overseas itself.  I’ve heard God’s voice on that enough times to trust that he wants me somewhere for some length of time at some point in the future.  But I still don’t know where or in what sort of context, and I’m nearing a point where I may have to make some decisions as I have one year of residency left. 

In general, I do have some personal sense of the importance of serving the poor as part of what it means to be working with God to bear witness to and bring about characteristics of his Kingdom.  But does that mean a certain percentage of my patients should suffer from the diseases of poverty?  Or that I should have to live a certain standard of living to really serve the poor?  Does that mean that most of my patients would die if I weren’t there, or is that simply me wanting to feel necessary and affirmed in my work?  If I were in a situation like Zambia where there is tremendous need and simply not the resources (people- or finance-wise) to meet it, would I still have the time in my schedule and energy in my life to reach out to people’s spiritual needs, or would I be so stretched thin and overworked that all I wanted to do was go home and sleep at the end of the day?  What would that sort of life look like with a family? 

Clearly a lot of prayer and discernment is still needed in my life over the next year(s).  I think a few good books on different styles of missions might be helpful.  I hope to continue talking with both the missionary contacts I have made and with mentors and friends in the States as I walk through this process.  God has been faithful to guide me clearly in each of my major life decisions to date (college, seminary, medical school, residency), and I can choose to trust that he will continue to do so.  In the meantime, I can also look for ways to learn more medically and missiologically, seek to do my best at working cross-culturally in a sensitive fashion with patient encounters that I have, and grow in loving God and allowing his love to overflow in me to others around me so that I can offer the life-transforming power of His grace to the needs that modern medicine