beach at Da Nang, Vietnam

Early one morning, while I was staying at a hotel in Da Nang, Vietnam, I took a walk along the beach. It was probably six o’clock when I stepped out of my hotel room and made my way down to Da Nang Bay along the Pacific Ocean. When I arrived at the water’s edge, I looked down the beach and saw hundreds of local Vietnamese people all dressed in long black pants and black shirts. Almost like an uncoordinated flash-mob, they were all doing stretches and yoga-type movements.  The whole scene took me by surprise and seemed very surreal.  My first thought was that I had happened upon a kung fu camp being hosted by the hotel, except for the fact that each person was acting independent of the others with no sign of a leader calling out instructions or orders. As I walked down the beach in my blue sweatpants and white t-shirt and extraordinarily white skin, I stood out like a sore thumb. People were nonchalantly staring at me, though they did not break the concentration of their exercise routine. I continued to be amazed at the sheer numbers of people and the commonality of their actions.

After my short walk observed by hundreds of eyes, I returned to the hotel to get ready for the day. Before leaving for my meetings, I decided to return to the beach for one more look at the ocean.  Once at the beach, there was not a single person anywhere in sight.  It was as if earlier, the entire city decided to go to the beach at one set time to exercise, and now 45 minutes later, they had departed, as a community, for the next event on their collective daily agenda. I did notice in all my travels through Vietnam that there was a commonality of schedule that created a real sense of community.

I am reminded of the story in the Gospel of Luke in which ten men suffering from leprosy were healed by Jesus.  The story has a number of powerful messages, but one is the fact that each of these men were now able to be integrated back into their communities.  Previous to their healing, the law excluded them from community with others due to their disease. But after being healed, they could now socialize freely, conduct business, and reconnect with family. Similarly, so many of the conditions that are treated at CURE hospitals exclude the inflicted child from being a part of the community, especially playing with other children and going to school.  After receiving treatment at a CURE hospital, the patient and their care-giver can now return to their villages, healed,  but also with the additional gift and blessing of community.

Jim Cohick at CCW training event in Haiti

I cannot believe we are already nearly two months into 2012, yet in other ways I feel farther down the 2012 timeline. I have had a busy schedule since the first of the year with trips to Honduras and the Dominican Republic, and meetings in Washington, DC. As I write this, I have just completed a week-long trip in Haiti (my first trip there). For the remainder of the month, my plans have me in Boston, then off to Uganda for about eight days.

In Honduras, the primary reason for my trip was to connect with the CURE Clubfoot Worldwide (CCW) Honduras coordinator, Grace, and medical director, Dr. Vasquez. He is extraordinarily busy, so most of my time was spent with Grace. Dr. Jay Bridgeman, an expat orthopedic surgeon whom I met on my prior visit, is involved with a number of initiatives that combine efforts of CCW and the CURE hospital in San Pedro Sula. Grace is great to work with, and we settled some CCW-related administrative matters. She is also able to understand how to arrange needed meetings with key players outside of our CURE programs to help our efforts for collaboration. She was instrumental for setting a meeting with the employer of a Honduran neurosurgeon we are scheduling to train in the CURE Hydrocephalus surgeon training program at CURE’s facility in Uganda. The result of this meeting ultimately helped finalize the outstanding items for this training to occur. She is working with both Drs. Vasquez and Bridgeman to leverage the CCW clinics — over 15 locations — for raising awareness of other CURE hospital services.

In the Dominican Republic there are continued challenges for our hospital in Santo Domingo and the CCW program. Brusy is the CCW DR coordinator, and Dr. Vidal, an orthopedic surgeon at a Santo Domingo rehabilitation hospital,  has recently taken the reigns as medical director for the CCW DR program. There are six clinics around the country — two in Santo Domingo, and one each in Santiago, San Francisco, San Juan, and Nabor. There is always a need to at least periodically review the effectiveness of the clinis in quality and volume. Turnover in key clinical personnel, change in focus by the clinic partner, and other factors can create dynamics for consideration of changes to or even closure of a clinic. Creating more synergy with the CURE hospital and in-country abilities to raise donations are goals we agreed upon as priorities.

Security and personal safety issues remain a high concern, a priority, and a reason for prayer for all those associated with our hospital and the larger community throughout San Pedro Sula and Honduras, and to a lesser extent with Santo Domingo. Please keep these matters in your thoughts and prayers for our staff and their families, for the families and patients we serve, and for those who visit and support our hospitals and programs in these two countries.

I mentioned having meetings in Washington, DC; Tim Erickson, a CURE colleague involved with the emerging organizational operations for CURE Hydrocephalus, and I met with our government consultant with staffers from two congressional representative offices (Rep. Platts and Rep. Chris Smith), the head of an influential attorney lobbyist who has a strong personal connection to hydrocephalus with his family, and members of USAID. We chiefly spoke with them about Dr. Ben Warf’s recent published article about the effectiveness of the endoscopic treatment for which we train surgeons through our CURE Hydrocephalus surgeon training program. The article was published in November and used well-accepted public health metrics and calculations which USAID, the World Health Organization (WHO), UNICEF, and others measure cost-effectiveness. The conclusions of the paper show our program to be very cost-effective and compelling to consider for scaling up. Compared to published studies for vaccinations and HIV/AIDS treatment programs, our program returns more value. We hope this will create momentum as we look for USAID to create and fund a program for treating hydrocephalus in the developing world.

In Haiti, there was a training program for CCW held in the central plateau region, about four hours by road over the mountains from Port au Prince. Views on the drive were gorgeous. During the two-day training, we had 25 nurses and doctors from three different clinics in the central plateau region. Dr. Bob Cady, a retired US pediatric orthopedic professor from Syracuse, facilitated the training in coordination with Dr. Francel. They used the standardized curriculum created from surgeon trainers within CCW and part of the Global Clubfoot Initiative (GCI), a consortium of individuals and organizations involved with and committed to eliminating the disability caused by clubfoot across the developing world. This series of PowerPoint lectures was vetted last October by the team of orthopedic surgeons that are part of the CCW India program, also known as CURE International India Trust (CIIT). The CCW Haiti coordinator is Kendy, and the CCW program medical director for Haiti is Dr. Francel, who was an orthopedic surgical fellow with CURE, having spent time in our Santo Domingo facility and a number of places within the US and Canada. Here are some photos from this training event:

At the end of the trip, Dr. Cady, Kendy, and I visited a hospital where teams from the US, led by the University of Miami’s Children’s Hospital, treat children with hydrocephalus. On my flight home to Chicago, I met with members of the Miami’s Children’s team and shared ideas and perspectives on our initiatives. Dr. Ragheb, a prominent and lead pediatric neurosurgeon for the team, is a contemporary of Dr. Ben Warf and has arrived at the same conclusions as Dr. Warf for the use of endoscopic surgical techniques for treating hydrocephalus. We don’t know how his team and our program might converge for Haiti or elsewhere, but we are open to the possibilities and keeping in touch.

The threads that are part of each initiative, one for clubfoot and the offer for hydrocephalus, often appear and intertwine in almost everything I do — travel to existing programs, strategic planning for next steps, and pursuit of goals. That intertwining has been remarkable to me, though it probably should not be a surprise. I hope to understand how to bring more fullness to both initiatives through their combined and separate activities. I am reading Eric Metaxas’ biography on Dietrich Bonhoeffer. I am trying to understand his approach to defining his philosophy of theology, and the resulting extraordinary actions in extraordinary times. I wonder how I can apply these things to what I do — my role and application as it involves facing and combating two debilitating but curable medical conditions. I am convinced successes realized, as well as those to be realized, are the result of grace and blessings showered by the God we choose to serve.

Oasis Hospital, Al Ain, UAE

Good Morning from Al Ain, UAE!  We are home again.  I am sitting in the quiet morning in our new flat, sipping a mug of hot coffee.  Outside, the winds are blowing, rattling the windows, waving the date palms, and covering the cars and landscape with a fine dark sand.  We took a walk yesterday and soon found how the sand could penetrate into unprotected parts of the body.  Teeth exposed through simple conversation developed a noisy grit.  The scalp and face had a fine coating of dust.  Ear canals gathered small pools of sand as well.  The total head coverings were making more sense as we experienced  a wind storm of the desert.

The week ahead marks a major change for me once again.  I have just finished a month in Ethiopia, where the routines were different but the patient problems and methods of clinics and surgery were familiar.  Both Kenya and Ethiopia were African countries.  Both Kenya and Ethiopia have similar patient groups which are targeted by the CURE mission.  In both Kenya and Ethiopia, the orthopedists essentially set the schedule and run the medical aspects of the hospital.  Not so at CURE Oasis in Al Ain.

I am entering a whole new world once again.  Over the years I have been in many different practice situations.  I have been a member of a multi-specialty medical group. I later joined a single-specialty orthopedic group.  This group was improved by the addition of a physical medicine specialist.  I was later called to leave my practice and become a missionary in a new hospital.  Moving to Kenya was without a doubt the biggest step of faith in my life up to that point.  After many years, the newness of CURE Kijabe settled into a comfortable routine.  Comfortable routines are just that — comfortable.  We all enjoy the predictability of routines.  Change and the thought of change is not comfortable.  Many of us cling to routines to the exclusion of all opportunities of growth and adventure.  Routines can become our idols of daily life.  And then something unexpected — and sometimes unwanted — enters.

Sometimes this guest can take the form of illness.  You are cruising along in your comfort zone and suddenly a  strange bump is found, your chest feels like it is being squeezed tightly, your child falls ill, or something else.  Or maybe you are driving along and a deer jumps in front of your car and you crash.  Your plans veer  off the path of predictability into hospitals and uncertainty.  Priorities change dramatically.  You reassess your life from a completely new perspective.

Another enemy may involve your job.  A new company takes over and you are ‘downsized’ out the work force.  A new boss arrives and changes the way you are to function within the company and you hate your new job.  The company offers you a new position across the country from where you are living.  You need to leave your friends, family, home, and enter the unknown.

Change. No one really enjoys the process.  Change in itself is not often the issue, but rather the unknown that change represents.  “What does this change mean for me?  Is this a good change or one that will be painful?”  Minds race; scenarios come and go.  The mind considers options from those closest to the prior life to others involving dramatic, often surrealistic circumstances.  Sleep can be fitful.  Weight may fluctuate as you seek comfort in things.  Moods may crash or rise to manic heights.   And then it is time.

“Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance.”  These are the words of James.  I return to them often in my life as I face changes.  Trials do not necessarily have to be major life events; those trials are just more obvious.  Trials can be occasions when you are asked to compromise your integrity for expediency.  Trials can be how you respond to any given situation.  Do you respond with anger and lose control of your emotions?  Do you wallow in the realm of “why me?” Or do you concede you do not know the ‘whys’ of life but live in a knowledge there is a greater force than you in control?

Tomorrow I start a new chapter.  We moved to Al Ain a few months ago and have been exploring some of the area and the culture.  During this time we were definitely outsiders not quite invited into the party.  We wandered the outside reaches, but tomorrow we enter the door.  My licenses are complete.  My visa is pending.  I have been assigned a place within the Oasis building to see patients.  A slot is being created in the operating schedule to accommodate an unknown quantity called “CURE Orthopedics.”   New rules and regulations abound as I embark on a journey very different from the one I left.  I am the “new guy” on the block, starting a new department in a new culture.  Although the most visible change may be minor to most people, this change will bring the most smiles and laughter among those who know me.  The culture here mandates that I wear a tie to clinic!  Yikes!  Ever since my residency training, waaaaay back in the dark ages, I only wear ties on rare occasions.  Usually I wear weird and strange ties since I consider ties a strange practice.  So here we go.  I even bought a few new, more conservative ties to try out.  We shall see how this practice goes over the next few months. (No, I am not including a picture of me in a tie.  I will leave that to your imagination.  Who knows?  Maybe I will come to enjoy a tie.  Yeah, right!)

Starting over again in a new culture, a new department, a diverse group of people, a small fish within the bigger pond, no residency, electronic records — all are changes that start tomorrow.  Am I nervous?  Of course.  I think change brings out our concerns, both real and imagined.  Do I want to quit and return to my comfortable life?  No!  Although the temptation looms great, the option to return is merely a temptation.  I know I have been called to embark on a new challenge and a new path.  I know this path will have its mountaintops and valleys, rocks and smooth paths, laughter and tears.  I know because I have traveled the paths of change many times.  I know because I am lead by someone greater and far wiser than me.  I know because I travel life in His grip.

Last week, children from CURE Zambia showed their support for the national soccer team, Chipolopolo (Copper Bullets). The team went on to win the title game in the Africa Cup of Nations, defeating Ivory Coast, 8 - 7, this past Sunday.

Yohannes has 12 children.  His last born, Hanna, is 12 year old when he brought her to CURE Ethiopia.  When Hanna was reaching one year old, she fell and, as a result, became crippled.  She couldn’t move from place to place and became very silent.  After the incident, Yohannes took his daughter to many hospitals, but there was nothing the doctors could do for her.

Hanna has never been to school.  Her father said he was embarrassed because of her deformity and he didn’t want to take her to school.  Hanna became a very sad girl.  Giving a smile is a very hard job for her.

One day in a nearby town, Yohannes heard about the CURE hospital from a doctor.  He heard disabled children are treated at CURE hospital for free.  Yohannes didn’t waste time to bring his daughter to Addis Ababa CURE Hospital. He was expecting a lot of process to see a doctor, but was accepted and guided to see a doctor right away.  He was so amazed by the treatment of the security guards and reception people. The doctor was also very friendly and gave him hope that his daughter may walk. For Yohannes, this was great news.  He called his family about the new hope, and the family rejoiced and waited for surgery day.  Hanna, too, was already excited by the news. She saw other children with disability in the compound, going out from the hospital being treated.  Her hope began to rise.  On the surgery day they were happy, thanking God and praying for successful results.

After all these things happened, Hanna is walking for the first time in her life.  The hospital provided her with brace shoes until her muscles get strengthened.  This brought so much joy to her family and her village.  It showed for the family how God restores the weak and help them to be free of shame and embarrassment.

Before Hanna came to CURE, she had to drag her buttocks and legs along the floor with her arms in order to get from place to place.  Her family members had to even carry her to the toilet.  Now, Hanna is able to walk one kilometer, and she is attending school.  Her smile comes much more easily these days.

During the video, the village sang a song of thanksgiving for us to enjoy.  As we watched this video together and heard her father share these words and listened to their song, I noticed the recovery room nurse Hamara, who was sitting next to me in chapel, wipe a tear of joy for Hanna from her eyes. It is so good for our CURE nurses to hear these words of thanks and encouragement, especially since their lives have become so difficult (Ethiopia has experienced 40% inflation in the last year, and their basic food staples have increased something like 300% over the last two years).

The LORD is the strength of his people,
a fortress of salvation for his anointed one.
Save your people and bless your inheritance;
be their shepherd and carry them forever.

Psalm 28:8-9

Originally posted at: http://ethiopia.thebernards.org/2012/02/10/hanna/.

Leikum Bithanu, a CUREkid from Ethiopia

As many of you know, our CUREkids program has been up and running for over a year now. To date, over $725,000 has been raised, and, as a result and even more impressively, over 1,150 child have been healed through CUREkids.

That in and of itself is amazing recognition of the hard work and effort that many of us pour into this project each and every day. So, I wanted to start off by saying “thank you” from the bottom of our hearts as the CUREkids team. We couldn’t do any of this without God opening doors and providing possibilities beyond our imagination. Of course, God has also brought us our supporters, and we are immensely thankful for each of you that follow, pray for, and give to support the children of CUREkids. CUREkids has been an amazing journey so far and continues to surprise and astound us practically every day!

We are also extremely honored to be recognized by the Central Pennsylvania Business Journal as one of the top seven area non-profits for Brand Identity & Unique Marketing Campaign in their upcoming Non Profit Innovation Awards. This could be a huge win for CUREkids.

The awards are on February 21st, at 8:00am; if CURE wins, we’ll receive $2,000, enough to help heal two children!

Thanks for continuing to support the amazing work of CURE. We are privileged to serve along side of each and every one of you!

“NFL Star Tim Tebow Building A Hospital For The Poor” from Technorati

“The Good Beyond the Game” from Affect Is a Verb

“Tim Tebow Foundation & CURE International Combine Efforts to Bring Hope to Filipino Children” from TwitChange

CURE International

“CURE International — February Community Impact Feature” from High Impact Mom

CURE Niger

“Essay: My life as a spiritual director in Niger” from ONE.org

Omar's mom, and his baby sister, Aicha

Different things are funny to different people. Something that may tickle you may scandalize someone else. But one thing that I have found to be true across the board (within the limits of my considerable-yet-far-from-authoritative personal experience, of course) is that Africans love making fun of villagers. I guess it is kind of like The Beverly Hillbillies. For most Africans I have met, there is nothing more awesome than finding someone who comes from the village and doesn’t know how things work in the city. Apparently, it is hilarious if someone doesn’t know how to plug in a cell phone charger or has never seen a water faucet before.

I learned this early on. I remember the first African joke I ever learned, growing up in Togo:

Someone comes from the village and is given a glass of water with ice. It is the first time he has ever seen ice in his life, and he is amazed. After observing it for awhile he says, “I am going to take a big piece of this and put it in my well at home. Then the water will always be cold!”

I am sure there is some profound anthropological truth that could be extracted from this observation, and while I enjoy laughing at brusards as much as the next guy (a brusard is someone from la brousse, the bush – I am allowed since I grew up as one), it can be kind of mean.

Omar came to the hospital with his mom and his little sister, Aicha. He came because he had burns so severe on his legs and abdomen that he couldn’t walk. It happened during an accident when he was little, and now he is probably six or seven years old. Since coming to CURE, he has already undergone one surgery, and he is waiting for the rest. Omar has other brothers and sisters at home, but his mom brought Aicha along because she is so little. Also, she is too cute to leave behind.

Omar, chillin'

One day Aicha got sick, so Omar’s mom took her to another clinic that is next door to us. They could tell she was from the village right away. She spoke to them in Hausa (kind of the lingua franca, even though here in Niamey, Djerma is more commonly used), and explained to them the problem. They answered her in Hausa, and told her to wait while they wrote out a prescription for her. But in the meantime, they started talking about her in Djerma, thinking that she couldn’t understand them. They said all kinds of nasty things about her. They made fun of her for being poor, and laughed at her because she is from the village and does not understand.

“Look at her.”

“Pathetic.”

“She doesn’t have any money.”

“Nope.”

“I hope she doesn’t think she is going to get something for free.”

“She better not.”

“She should have stayed in the village.”

Omar’s mom waited patiently for them to finish. They handed her the prescription, she took it and said, “Thank you very much, and have a nice day,” in Djerma, making sure they knew that she understood everything they had said. They were shocked.

Some cheeks are made for squeezing

She came back and told the whole story to our hospital social worker. “It is so different here,” she said. “Here everyone is nice to us.”

I don’t mean to brag (well, actually I do, but I am not bragging about myself, so it is ok), but our hospital is pretty awesome. All the CURE hospitals are. At other hospitals here in Niger, you are lucky if people even acknowledge your existence. Forget about a bed to sleep in or food to eat. We provide those things to our patients, but even more importantly, we have doctors and nurses that really care about our patients, and treat them with love.

The nurses at the other clinic made a mistake. Omar’s mom may be from the village, and there may be a lot of things she doesn’t know. But she does know what it means to be treated with kindness and respect, to be shown love and care. These are things everyone knows, regardless of where they are from.

Also, she is a Fulani (read as “a nomadic polyglot”), and probably speaks more languages than they do. So, to put it crudely, “In your face!”

Beyond the houses, a distant hill rises like a high step to the sky.  A patch has been cleared, cut from within the forest, reminding me of the downhill ski runs during the summer months.  Above the view is the dark blue sky as far as you can see.  No clouds break the scene today.

My month has been a good experience.  I have been able to see and better understand the trials and successes of another CURE hospital.  Each of the hospitals has the unique challenges of the host country in which it resides and serves.  I also find that each hospital has a number challenges that are similar to those in other CURE hospitals.  All struggle with funding and staffing issues.  All have more children that need care than the hospital has resources to provide.  All face insurmountable issues that are economic, social, and mythical in nature.  Likewise, all need to remember the work is not our work but God’s, and He will provide.

The medical and social problems I saw this month remind me of my early years in Kenya.  I examined many children suffering the long term effects of polio — frail limbs dragging along, crooked feet, and no motor control.  We can stabilize feet and realign legs, but then there is still the muscle problem.  Long leg braces are expensive for the people who need them, and of course many do not want to wear one.  They want to be normal.  There are something like 100 million people here in Ethiopia.  Immunization programs in the remote areas would be costly and difficult.  I still feel we need to do this for polio and other diseases we can prevent.  They had a “Kick polio out of Kenya” program that was successful.  Prior to leaving, I had not seen a new case in years.  We spend a fortune on AIDS, which of course has value, but we don’t cure people.  Malaria, measles, mumps, and polio injure and kill many each year.  Maybe we need to re-balance our support a little.

Like Kenya, in Ethiopia we find advanced deformities not seen in the western world except as a novelty.  Twisted feet in older children, children with hips out of joint going without treatment for years, burn contractures, nutritional deformities, advanced bony infections, poorly treated or untreated fractures and more fill the outpatient clinics.  People travel long distances for the opportunity for their child to receive life-changing care.  I find it difficult to say “No.”  Sometimes the heart really wants to attempt a procedure, but your mind reminds you the procedure has very closely defined indications and limited goals.  You must remember a poorly conceived plan or operation may leave the family and, most of all, the child worse off than they are currently.  Understanding this fact is the basis of the shift from knowledge to that of wisdom.

Instead, you talk with the family and discuss the limits of medicine.  We talk about the child as a person and the intrinsic value he has.  I try to understand the stresses under which they live, but without the experiences, I can only guess the pain and the trials of their daily journey.

The needs in the developing world are enormous.  When I look at the whole picture, I find it very overwhelming.  Thankfully, I am not responsible for the correction of the whole problem.  Global programs are very difficult to manage and successfully pull off (Read White Man’s Burden by Easterly for his view).  I was given a heart to care for the disabled.  I can only do my part.  Will this make a huge change in the world?  I don’t know — I sincerely doubt any one person will have a huge impact — but it really does not matter.  I have been able to help a few children and families and train others to continue the work.  For those we have helped, life has changed.  Maybe one of children helped will become a person of national influence who has the authority to make major changes within their country.   Maybe others will have a vision to train additional doctors to care for their people.  Maybe others will lead the charge into honorable government with integrity.

That is what faith is about.  I travel day by day.  I do not see the big picture of life.  I am responsible to use my skills and gifts in service for others.  As I journey along I trust there is a plan and a purpose in life.  I follow my guide.  I travel this road in His grip.