Saturday, May 30, 2009

En la clinica

(For travel in Asia, go to 11/2008-1/2009)

Random thoughts in this last week of May, 2009. There were three Burmese (Karen) patients in the clinic today. Diagnoses included depression x 2, anxiety, insomnia, hypertension x 2, diabetes, nodules of unknown etiology, and so on. Two of the patients came in with our outreach worker and one with a woman involved in several Baptist-sponsored orphanages in Burma and on the border. So when Diana, the Grace pastor came down to the clinic for her weekly prayer with patients and staff in the waiting room, we all gathered (since swine flu, no longer holding hands) and Diana began her prayer (translated by Nora), with, “Dear God, our father and mother …” and meanwhile several of the Cristianas were muttering accompanying prayers and babies fussing and a toddler trying to get her mother’s attention, “Ma! Ma!” And there we all were, Mexican, Salvadoran, Karen, Mexican-American, Anglo – hearing and praying a prayer for healing, understanding, acceptance, and gratitude.

Photo above is borrowed from the Smithsonian Magazine article on Amerasians (June 2009). The older man at the table is Thao D (Uncle Thao), who came out of prison dedicated to liberating all people, including Amerasians. Uncle Thao is a Great Man, a manifestation of the beauty we all can be. See the upside down photo of the pretty girl with the checked dress on? I knew her too. Photo below: Pat B and one of her patients in the pharmacy. What a life we lead!

Later I wondered what people thought about the prayer to “God, our father and mother…”

I was saying to one Karen person, that when we were in Burma we were treated with kindness and that the country was beautiful. I didn’t say (and should have) that overall, it seems to me that people in & from Burma have a gravitas, a sense of dignity and substance. Back in the 1970s someone said, like royalty in tatters.

As part of her masters in social work, Erika R spent more than a semester in the Agape Clinic examining mental health disparities among Hispanics. Her most startling finding was that the main barrier to mental health services was that people were unaware of a mental health concern (72%).

(The following are conclusions drawn by me.) In other words, most patients who receive mental health care at Agape did not realize or acknowledge that they had a problem; they thought being depressed was just the way life goes. During the course of care for chronic or acute physical illnesses, patients are often asked questions like, “On most days are you mostly happy or mostly sad?” A positive response elicits further assessment questions and sometimes leads to the conclusion that the patient is experiencing depression and/or an anxiety disorder. Treatment is offered and provided when appropriate – in many cases, including further evaluation and treatment through Dr. K. Photo: in exam room 1.

Monday, May 25, 2009

Memorial Day 2009

I got the below email yesterday. My response follows. Photo taken at Con Thien, by someone else.

I'd like to express my appreciation for your articles and photographs. They first caught my attention last year when I tried to find info on some of the guys from Santa Barbara County, especially Jerry Georges. I went to jr. and senior high school with Jerry. I wonder if you would like to see a couple of pages about Jerry from our 1964 yearbook? He was student body president that year.

On my tour I passed very close to your area on my way to Vandegrift and other places up north. I was with an engineer battalion in III Corps.

Let me know and I will be glad to email the yearbook pages. I think you will find them interesting, especially in light of the kind comments you made about Jerry.

Thank you – yes, I’d like to see those pages about Jerry. Don’t know if you came across what I said about an older friend of mine bringing his close friend to our Bible study group a couple of years ago. The friend was from Santa Barbara and as it turned out, was a leader in (I think I have the organization name right) Young Life. Jerry was involved in that organization and my friend’s friend remembered Jerry with great warmth and respect. In my experience, Jerry was a good guy; I’ve come to realize that had he lived, he probably would have been a great man. What a loss. And here we are on Memorial Day.

Thursday, May 21, 2009

"I'll go"

(For travel in Asia, go to 11/2008-1/2009)

Last week I spoke at the main service at my church. The idea was that I would speak to the help given our clinic (Agape Clinic) by the First Presbyterian Foundation. During the service I sat next to Dan F, my spiritual teacher for these past 15 or so years and that was a great honor for me. Here is what I prepared for the talk and pretty much what I said:

A front page feature article in the Morning News today is titled, “Facing an Ailing System – North Texans figure out ways to cope as they find limited remedies for affordable care.”

The Texas Medical Association website reports 16% of people in America are uninsured and Texas is in (where else) last place with 25% of the population uninsured.

At Agape – with wonderful help from this church – we serve the uninsured, the working poor, the people who process the chicken we eat, who mow our lawns, who clean our offices and hospital rooms – we serve the people who cannot get Medicaid, who cannot access services at Parkland or Project Access or Homes or anywhere else.

We serve our patients and families and community with:
  • Primary care for acute illness
  • Specialty care, including psychiatry, dermatology, gynecology, pediatrics, asthma
  • Spiritual care (with help from our wonderful new Grace pastor, Diana Holbert)
  • Community education
  • Follow-up for patients with chronic illness
  • Health screening
  • Service learning site students from Baylor, UTSW, UTA and others

We are unique among community-based clinics in that we do all the above AND we are a medical home for people with chronic illness – the Morning News article gives some insight into how hard that is to find.

The FPC Foundation invests in the Agape Promotoras de Salud – the lay health promoters, women from the community (clinic patients) who triage and teach our patients, who teach in the community, who assist doctors and nurses, who provide spiritual care, who are the connections among patients, clinic, and community. When the swine flu thing started nobody knew how it would go – a disaster or just another variation on influenza (pretty bad in itself!). I asked the promotoras if anyone would work the fever, cough and congestion hall with me and Irma said, “I’ll go.”

A moment ago I said, “with wonderful help from this church” – I was referring to monetary help. But I also mean other sorts of help – the support from the men in G5 Men’s Bible Study – and especially I meant the support, when I have nothing left to give, of a church where we’re taught that practicing mercy is a spiritual practice. And it’s not a theoretical teaching – it’s reality here, in the lives of teachers, at the Stewpot, in hospital visits, in support for incarcerated youth, in people’s homes when Cynthia brings communion to the sick and the dying. It’s a good church.

So, on a personal note, it’s good to have a church home and I thank you.

Monday, May 11, 2009


(For travel in Asia, go to 11/2008-1/2009)

May 1st & 5th - Here we are in the time of swine flu, nobody knowing how it will play out and the way we’re addressing it at Agape is to triage patients at the door and send everyone with flu-like symptoms one way and everyone else through the waiting room and on into the clinic. Irma, Pat and I are seeing the patients in the fever, cough, etc. area. I’m thinking, well, here I am again.

But what prompts me to write (now that the swine flu crisis seems to have passed) is that I saw this photograph of a young woman named Thao (one of my favorite names) studying in her dorm room in medical school in Haiphong. Check out that desk, and the closet at the head of the bed, and how about the mattress (we're thinking the bottom bunk is the same). An Australian woman we know - Alison - created this extraordinary opportunity for Thao to go to medical school. Thao's family is very very poor (single mother, seriously ill, forages in trash to survive) and there is no chance she would have made it without Alison and you, Alison, are the salt of the earth.

As I think about being back in the mountains, looking at photos of the Beartooths and Wind Rivers, the swelling in my chest feels almost physical. What a great thing it is to contemplate the (likely) reality that I will again stand in the cold alpine wind in the high mountains, surrounded by raw and sublime beauty. What a thing to be here! Alone on a high mountain meadow in August; by icy tarn waters, looking up at the night sky with stars by the millions right here/now, sitting among a million tiny alpine flowers, scrambling across rocky domes, and here come the clouds and soon the snow – first flecks of sleet, more, now the snow – ahhh.

The things that helped me get going into the mountains again include:

  • The Sierra Club took me on my 1st return trip – Big Bend for a wonderful time.
  • The forum has been immensely helpful in giving me knowledge and inspiration. Hikerjer (words) and swimswithtrout (photos) show the true heart of the matter and I’m grateful to them.
  • Always, of course, Leslie, my beautiful understanding and supportive wife (and partner in the back roads and alleys of Southeast Asia).

Clarification on no “I” “to be” – not here, of course; and it’s incomprehensible to think that this “I” would endure beyond death. I mean, what a disappointment to still be regular old me with my weaknesses and faults and lies hopefully (even if still just barely) outweighed by my strengths and goods and truths. AND an infinitely higher I (and of course, thou) seems certain.

When you find out who you are, beautiful beyond your dreams.