Operating Onboard the Africa Mercyship

The large vessel pictured here is my temporary residence in Monrovia. This enormous hospital boat is docked here in the country of Liberia for a couple of months and is run by Mercyships. I am here for 3 weeks doing surgery (mainly hernia repairs).

The six operating rooms on board are shockingly well-equipped, and the amenities are fabulous - we even have air conditioning. The boat is so large that I sometimes forget that I am even on a boat, until I look out and see the horizon bobbing up and down.

One highlight thus far has been experiencing the community life on the boat. Eating, working, worshiping, playing, and interacting with the same 400 people from dozens of countries creates a very unique environment on board. Despite the diversity and rapid turnover of short term personnel, relationships are rich and the hospital care is of a very high quality. I'm looking forward to 2 more great weeks.

Jason Departs

The Faders are driving to Chicago tonight and Jason will depart for Monrovia, Liberia, tomorrow, as Heather and Anna go on an extended road trip visiting family and friends while he is gone. There is some Internet connection on the ship, so check in to the blog in the next few weeks, as we hope that Jason will be able to relay some of his experiences. Please remember the Fader family in your prayers until their return (and even afterwards, if you really want to).

The University of Michigan and Africa

All of the McCropders have lived in Ann Arbor for part of the years of medical training, and this makes for an irresistible association with the University of Michigan, stronger for some of us than others.

As a whole, we see this as a huge plus, and the connections with the University will likely have effects in years to come that we can only hypothesize about at the present. As it turns out, within this vast health system, there are a number of medical projects in Africa, and we have been trying to understand these and how we might fit in.

Yesterday morning, Jason and Eric had breakfast with Dr. Andy Haig, Professor of PM&R (physical rehabilitation), who has been involved in two of U of M's Africa projects. The largest project is in Accra, Ghana, where for many years the health system, particularly the OB-GYN department, has been involved in medical education. The most impressive thing that I've heard from this thus far is that, during the time of their involvement, the number of trained OB-GYNs who finished and then stayed to practice in Ghana has risen dramatically. In these times of the highest educated Africans leaving their homes in the so-called "Brain Drain", the significance of this can not be overstated. It is our understanding that U of M is wanting to expand their involvement in Ghana in a big way over the next several years across the board, to include not only different medical fields, but business, pharmacy, nursing, engineering, social work, etc. - a very large endeavor with ambitious but feasible goals.

Dr. Haig has been involved in a smaller project in Liberia, in conjunction with Mercy Ships, in which he has met with numerous people in the government and medical education, regarding possibly developing some kind of Rehabilitation program, which is virtually non-existent there at present. He told us about the state of education, namely that clinical faculty to teach the students are exceedingly rare in these years of post-civil unrest, and thus the graduating physicians are notably undertrained. It's interesting for us to consider this (or a similar opportunity) as a place to invest in the future.

The last project with which we've become acquainted is headed up with the help of Dr. Rusty Chavey, who is also Eric's advisor within Family Medicine. A couple years ago, he teamed up with the U of M business school and they have been working with a hospital in Uganda, with a goal of helping them to improve the delivery of medical services and their own business model, to the end that they could be more financially self-sustainable, and stretch their resources further to provide more care.

What is the PRTP?

We have written a little bit about this before, but given the recent news that all of us will, in fact, be spending our first two years abroad with this program, we thought it worthwhile to give a little more explanation.

The Post-Residency Training Program is a 2-year fellowship funded by World Medical Mission, the medical arm of the larger international relief organization Samaritan's Purse (which is chaired by Billy Graham's son Franklin). WMM does a lot of short term work (including sending the McLaughlins to Bangladesh last year), but is not a long-term agency, and thus we will be looking for another sending agency when our 2 years is up. This fellowship program has been sending people out for a few years now (not just to Africa, but all over the globe), and its purpose is to bridge the gap between residency and longer term work by providing funding and mentorship while you work in a hospital in the developing world.

WMM partners with dozens of hospitals around the world, that are run by other organizations. When someone (like us) is accepted into the PRTP, they will work under one of these mission hospitals, where the fellow provides staffing, and the long-term docs provide mentorship - medical, cultural, spiritual, etc... A big plus for this is that expenses are covered by WMM, including travel, and they partner with Project MedSend, who, in the past, has been very ready to cover student loan payments for the fellows for the 2 year period.

They have never taken on a team of 3 families (4 doctors) before, and we appreciate the flexibility they have shown in working with us. Now begins the location question, but more on that later.

A Big Step Forward

As of yesterday, we received word from Scott Reichenbach, director of the Post-Residency Training Program for World Medical Mission, that all of us have been accepted as fellows into their program, for the two year term starting next fall (2009).

We will be posting more in the next few days regarding this development, regarding more specifics of the program, as well as what this means for location, which is always everyone's big question (ourselves not excluded). For the time being, we'll say that we are all very excited, because (1) this was our preferred path for starting out on this road to African medicine, and (2) that after many months of plans and discussions, we are taking a large step forward together.

Liberia?

Throughout the summer, we McCropders have continued to ponder long-term locations: Sudan, Swaziland, Niger, Zambia, Equatorial Guinea, Liberia? Each option presents its own interesting mixture of situational intricacies.

One of the countries we have discussed is Liberia, a post-conflict nation in West Africa. The medical need is great, and the post-war situation affords opportunities to positively impact the rebuilding process. We have entertained the possibility of pursuing faculty positions at the medical school.

I, Jason, was recently presented with an opportunity to work in Liberia from September 14 to October 4 as a surgeon with Mercy Ships. I jumped at the opportunity, eager to help and excited to explore future McCropder possibilities. I also anticipate stretching my surgeon wings on what should be some interesting and challenging cases. Like a cantaloupe-sized thyroid for example.


I am looking forward to a stretching, exciting, and enlightening three weeks with Mercy Ships!

Paradigms - Part II: Henri Nouwen Book Titles

As the ideas discussed in the prior posting swirl around in my head and heart, a phrase climbs slowly out of the fog, giving itself an extra prominence: The Wounded Healer.

The Wounded Healer is a book written by Catholic priest and contemplative writer Henri Nouwen in 1972. Nouwen was a fascinating man, and the book a worthwhile read, though the title itself has more bearing on the present discussion than does the content of the book. The phrase, of course, makes me think of Jesus, and Nouwen uses it to describe us as we imitate Christ. It does not at all remind me of the medical institution’s image of its own practitioners. There, the two pervading images are, either the healer who needs to be whole himself/herself before extending help to others, or the healer whose personal condition has no bearing on his/her healing work.

How is Christ a “wounded healer”, and in what sense are supposed to imitate this? I can think of two ways. First, Christ’s wounds are substitutionary, as Isaiah wrote centuries before Christ, “The punishment that brought us peace was upon him, and by his wounds we are healed (53:5).” Because he was wounded, we no longer have to be. I can envision a few glorious human examples where one might imitate this (such as the end of A Tale of Two Cities), but overall this provides little in the way of guidance for my own medical practice.

But there is a second and more subtle way that Christ may model the “wounded healer”. The unknown writer of the letter to the Hebrews writes that part of the reason Christ is the greatest “high priest” (able to mediate perfectly between God the Father and mankind) is because he “has been tempted in every way, just as we are – yet was without sin. Let us then approach the throne of grace with confidence, so that we may receive mercy and find grace to help us in our time of need (5:15).” Did these temptations “wound” Christ? I do not know. But what is evident is that the personal story of Christ (both its ebb and flow) enables his healing of others, instead of detracting or even distracting from it. There is potential here for an appropriate guide for us to model. But how?

I do recommend Ellen's comment from the first post for more food for thought.

Paradigms - Part I: Medical Care for Friends

We were asked the other night how we felt about being the medical provider for our friends. This is hardly a theoretical question, as Rachel has agreed to provide obstetrical care for a good friend of ours. The institution of medicine does not provide a definitive stance on this, but it does provide a thought framework that lends itself to a certain position: We are uncomfortable with it, because though it may be enjoyable and rewarding as long as everything is straightforward, the possible threat to our personal relationship that is created by a possible bad outcome is a risk most are not willing to take. You are caring for a friend, and they are diagnosed with late-stage cancer. Will you ever be able to forgive yourself for not finding it sooner (even if there is nothing to forgive)? What will become of your friendship and the relationships you hold in common?

We recognize that we had better make peace with this. If my appendix ruptures in a couple years, Jason Fader will become intimate with my colon, and will have to deal with the responsibility of operating on me. If little Elise Cropsey gets malaria, it will likely be my treatment plan that will recuperate her. This is part and parcel to a desire to work in an area where there are minimal other medical providers.

The medical paradigm that creates these (and other) levels of discomfort with treating friends seems to be this: You are the patient. You are coming for help. I am the doctor. To best help, I need to be disconnected, and thus objective. I should not be bringing my personal story into yours, because this is about you, not me. And from this comes a separation between your patients and your friends, for friendship requires a give and take, an intermixing of personal stories. I think that our pastor at Knox was correct is stating this is likely an outgrowth of medicine’s modernistic bent.

And so I question this: Is it really possible to separate yourself personally from the patients you treat? If so, does this really provide objectivity? Does objectivity lead to healing? (If a person can be treated as a scientific physical specimen, then perhaps.) Is this a paradigm that will make a drop of sense in Africa? Is this consistent with Christianity?

More to come, but I would appreciate any thoughts from those who may read this.

The Devil Came On Horseback

At the recommendation of the Cropseys, we, the McLaughlins and Faders, got together with some friends last night and had a viewing of The Devil Came on Horseback, a documentary about a young retired US Marine who travels to Darfur and ends up with a photographic exposition of the atrocities there. It is a fine film, chosen for the Sundance Festival last year. We thought it would be an interesting way to learn more about this conflict and engage some of our friends on a situation dear to our hearts.

Jason's brother Caleb, who is heading out next week for 2 years with the Peace Corps in Uganda, spent 2-3 months in Darfur drilling wells last year. Thankfully he was in town and able to be there, and provided some very personal perspective to an already personal documentary.

David Durham (my brother-in-law's father) wrote that much of the sentiment over Africa can be summed up in a single letter: "O". As in, "O Africa!" The tragedy, the joy, the horror, the need, the gift.

As eight young Americans sat around after our movie last night, it seemed that everyone's heart was crying out "O!", but when we tried to decide what to do, the complexity of any solution loomed large. I do not claim any exhaustive knowledge of world affairs, but it does seem that the greatest world crisis currently is Darfur, with millions displaced, and over 400,000 killed. What to do? Be aware? OK, we can do that. Tell others? We can do that, too. Support sending in armed forces and be involved in another nation-building event? Maybe, but our collective wisdom seems not to be sufficient to answer that definitively.

Pray? Yes, we can pray. God, help Darfur. Help us to know how to act justly. Bring healing, wholeness, peace.

Medicine and the 4 Levels of Happiness

Several years ago, I heard John Patrick speak at a conference, and he talked about the 4 levels of happiness. The first and lowest level is animal happiness, that is, our hungers, thirst, physical drives. The next level is discipline happiness, or the happiness that comes from applying yourself and acheiving that goal, such as in athletics or academics. The third level is that of needing to be needed, which can result in altruism. The highest level is that which comes from knowing and loving God (and, I would say, being known by and being loved by God). It's a very Neoplatonic idea, in the sense that we strive to aim for the higher levels, while de-prioritizing but still enjoying the lower levels.

At first blush, I didn't see much more than an interesting thought exercise in this, but later my friend James (of the Lyntelnosters) gave me pause to think how the work of medicine fits into this. I think two things can be gleaned:

1. Medicine is fundamental: This is the gravity of what we do. When physical and mental health deteriorate, the ability to pursue any of the happiness mentioned above is seriously challenged. This is the reason people will drain all their resources to pursue a cure; because what good are all these resources if I'm not alive or functional to pursue any other happiness?

2. Medicine is foundational: To me, this is the other side of the coin. What we do gives people the lowest level of happiness mentioned above, but that's it. Whether anything higher is achieved is up to them. Yes, physicians can help people to pursue higher happiness, but at that point, most people would say they have gone beyong the limits of medicine and into some other service more common to friendships than doctor-patient relationships.

So, in this light, medicine becomes humility and honor. It reminds me of a scene from Lewis' Narnia: "'You come of the Lord Adam and the Lady Eve,' said Aslan. 'And that is both honour enough to erect the head of the poorest beggar, and shame enough to bow the shoulders of the greatest emperor in earth.'" Those of you who didn't think this was going to come around to CS Lewis ought to have known better.