Baby, baby (and other paediatrics)

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Paediatrics. I made notes on the whole course in 2012 – you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

After all the fun of last night, it is no surprise that there was lively worship this morning. After two hours last night, and half an hour this morning, my fingers are tired of strumming!

Greeting from BotswanaNeonates in the Developing World

There were some big messages, and scary statistics.

No more shall there be in it an infant who lives but a few days, or an old man who does not fill out his days, for the young man shall die a hundred years old
Isaiah 65:20

If you include stillborn babies, then 75% of deaths in under 5s are in neonates.

50% of neonatal deaths are in the first 24 hours. 75% are in the first week.

Malnutrition

Nutrition is responsible for 30-50% of child deaths, and also leads to low birth weights due to maternal mortality.

Urgent referral for kids:

  1. Inability to drink or breastfeed
  2. Vomiting everything
  3. Convulsions
  4. Lethargy or unconsciousness

32% of children in developing countries have stunted growth due to malnutrition

Stuff to read, when I stop being useless…

  • On our CMF USB stick, there is a highly recommended Pocket Book of Hospital Care for Children, which I shall read, when I sort myself out.
  • Unicef State of Child Health.
  • Lancet Global Health Series can be read free online.

 

HIV, Mission and Song

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is HIV & AIDS. I made notes on the whole course in 2012 – you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

This morning started with a brief spot in chapel, with a preach that focussed on Matthew 13:44-46, more about treasure, all fitting in with the message of being aware of our glorious inheritance (from Ephesians).

The kingdom of heaven is like treasure hidden in a field, which a man found and covered up. Then in his joy he goes and sells all that he has and buys that field. Again, the kingdom of heaven is like a merchant in search of fine pearls, who, on finding one pearl of great value, went and sold all that he had and bought it. Matthew 13:44-46

A wider vision to cure HIV

DifaemGisela Schneider asked us some difficult questions…

Why are we here? Why are we doing Medical Mission? What is our role, what is our ministry as Medical missionaries? There has been a sea change in how we, as the church, do mission work over the last few decades:

No longer pioneers, but partners.

HIV is not a medical problem: its a social one that needs churches, politicans, traditional healers and schools working together. Obviously, when things happen like the health minister for South Africa announcing on national TV that beetroot was a cure for HIV, that holistic solution is not being helped!

My friend Marli recommended that I try to attend the SA HIV Society 2014 Conference, where I could learn about how this problem is being addressed in the country…

Gisela shared with us the declaration made at the Difaem international health conference she just got back from; they made the declaration, then spent a few days trying to work out how to address it. You can read it here: A_call_to_health_and_healing_-_Declaration_Tuebingen_III 2014

Talking to a Missions Agency

During the morning today, I received an interesting call, from one of the organisations I emailed last night. I was blatant, honest and fairly excited – hopefully giving a realistic impression of what I’m like usually.

Frankly, the conversation was encouraging: we were on the same page spiritually. Some excellent new Christianese jargon about people being “Sent” church or “Local” church, but ultimately a passion to see the Kingdom come, to see lives changed, a world impacted, and walking alongside others authentically. We agreed to meet on Monday morning, with my wife and his, to see if we may be a fit for each other.

Even that little detail – us meeting his wife – just confirmed the focus on relational work these guys are into. I’m not sure where Christian Gender Equality is currently up to, but I believe that husband and wife are a unit, and so with something as personal as working together on mission, its pretty important we are all “agreed”, to quote Amos 3:3.

2 hours of African singing

I’ve been vaguely leading worship at the conference morning devotionals, but some of the African delegates wanted to make it, well, frankly, less white, so we had a little worship practice in the evening.

It lasted 2 hours, it was tremendously fun, and it kept nearly stopping, then starting again. You can see a clip of it below…

Bugs, and passions that won’t let go

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Tropical Medicine. I made notes on the whole course in 2012 – you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

Two things made today different. Firstly, for the next two days, my mum has joined the course. It has been lovely: so nice to spend time with her; we are both doctors, and having a shared purpose and heart is a joy. We are in three families together; biological, professional and spiritual, and that makes me very happy.

Secondly, I got in from a stag do at 3:30am, and was not able to pay attention tremendously well today…

Tropical Medicine

One person shared about the fact that in some areas of endemic shistosomiasis infection, it is widely accepted that boys have a menarche. In other words, the parasitic infection causes blood in the urine, and it is so common, that it is thought that boys have a period, just like girls, in their wee. On many levels, it is amazing that something so wrong can be accepted as the normal.

We had some small group sessions where we talked about how to deal with hospital workers getting TB. There was a great idea bout offering hospital staff free healthcare (obviously more relevant in countries without free universal coverage), and of automatically offering an XR and sputum analysis for anyone who has had a cough for more than 3 weeks.

I’ve definitely been getting excited about the potential for community health development in Tonga, when we get out there, and some of these ideas are a big challenge.

Mortality and Malaria

The Malaria lecture ended with a shocking reminder: 1,000,000-3,000,000 deaths/year >90% among African children.

140,000 people died when we dropped atomic bombs on two Japanese cities in 1945. There is a memorial to these people in London. However, its important to remember that in 1945 in Africa, around 3,000,000 children probably died from Malaria. And in 1946 in Africa, 3,000,000 children died from Malaria. And in 1947… 1948…

Why do we not hear about this more? Because malaria is predominantly a condition affecting young african children living in absolute poverty.

Malaria LifecycleMalaria Lifecycle

  • 1 mosquito bite
  • 15 sporozoites
  • Each Sporoziote matures in the liver and releases 40,000 Merozoites.
  • The Merozoites join a red cell and become a Trophozoite.
  • These mature, and become Schizonts and release more Merozoites – 16 per cell.
  • Finally, at some point, Gametocytes are formed from Trophozoites.
  • They are then picked up by a mosquito drinking your blood.

Absence of fever DOES NOT rule out Malaria!

Interpreting a blood film.

Three things to know:

  1. Infecting species
  2. Density of infection – no limit to % – people have been known to survive 70%.
  3. Stage (trophozoites vs schizonts) – if there are lots of schizonts, its a sign that within the next 24 hours the density of the infection is about to massively increase.

You can bring about a 60% reduction in all cause mortality in under 5s by sleeping under a bed net.

Which is so much more effective than the value of statins, or extra antihypertensive agents. But we don’t hear about it.

Missions Fair

IrresistableRevolutionBeing surrounded by people on medical mission, I’ve noticed that almost everyone is going out with an agency or some sort of organisation supporting them. It’s important to have a church that sends you out, but sometimes they do not have the breadth of cross cultural experience that can be helpful in international mission .

Me and Katherine talked about it, and agreed we wanted to see if there was an organisation that would be interested in providing that support.

So I went to the missions fair, where there were 20ish organisations that provide training, support, finances, programmes to join, short term trips to fulfill. And I said

“Hi, we kinda want some sort of support, but don’t really know what… Can you provide that? Oh yeh, and we fly out to South Africa for a year in like 6 weeks…”

To say that people visibly recoiled wasn’t altogether inaccurate. Ultimately of the 20+ agencies, nobody really felt they could help us. Probably pretty wisely.

I spent the evening in crazily deep conversation with Jon (the collie dog owner from yesterday) and discovered that he and his wife are joining a fairly radical group of “New Monastics“, a concept I’ve previously come across through reading various books by Shane Claibourne (see right). In fact, its a passion both me and Katherine have both shared so passionately that we spent our first two years of married life living in community

So, long story short, I spent my last hour before sleep chucking emails at missional community based organisations, along the lines of Urban Neighbours of Hope, The Simple Way, InnerChange, Word Made Flesh. I couldn’t sleep until I read Ephesians 1 again either! Our email is below, a quick, honest missive to see if God has anyone for us…

Hey there,

My name is Chris Lowry. My wife and I, and our 1 year old and our 3 year old
are going to Africa for a year in AUgust.

We aren’t going with a missionary organisation (yet) but we do feel God wants
us to go. I’m a doctor, so we will be working in a hospital out there in
Tonga, in Mpumalanga (SA) and we have a wage coming in.

Err, would you provide (non financial) support to people like us?

C

Good Mental Health

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Medicine. I made notes on the whole course in 2012 – you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

Cycling in

This morning I cycled to the course from Epping to Oak Hill College. It was pretty fun, but Google Navigation was keen to have me climbing bridges, weaving round railings and, most annoyingly, kept saying “turn left” where there was no road: and I didn’t realise that it meant not a road but a foot path, so spent minutes cycling back and forth, trying to work out why the road disappeared into a field…

You can click the map below for all kinds of useless information about speed and route. It took a while, but I had a great time. I’ve gained an appreciation of how much ancient forest and lovely green space London has…

Bike Ride

 

Mental health

As Maureen Wilkinson explained, in Africa, psychosis will jump out at you, but depression hides. Dealing with depression in Africa can be very difficult.

Shared the story of meeting a chap called Barry in 1988, whilst working in Kenya. Didn’t think about it again for many years, until someone mentioned reading a book by an American that mentioned them. Eventually they found it: the book was by a man called Barack Obama…

Never underestimate the power and potential of any human.
The people you heal, you train, you save: they are the future of humanity.

Ophthalmology

David Yorston was speaking about the joys, challenges and skills in working with eyes in Nepal. I was reminded that I find ophthalmoscopes very frustrating

People have a superstition that dilating the eye is very risky – generally not true – but if you do it, you will see the back of the eye – maybe for the first time in your life!

Measurements 6/18 – this means you can see at 6m what a normal person can see at 18m. A vision of less than 3/18 is a definition of blindness.

manandgirlOn the right is a picture of a man and a girl. The surgery to resolve his cataracts didn’t just change his life, it allowed the girl to go to school, it meant that she is much more likely to look after her own children, and reduce under 5 mortality. So the surgery on one man saves the lives of children who haven’t even been born yet.

This is the exact hope I have for all my work: leading worship, medical revision websites, this blog: impacts on lives multiplicating to achieve so much more than the original work would imply.

Dogs vs Episodic Foreign work

Had a great chat with a chap called Jon. A fellow dog lover, he and his wife are having to find a new permanent home for their 8 year old collie, whilst they go off to live in Asia for a long term mission. A terrifying prospect to those of us who own… an 8 year old collie. It was especially heartbreaking to hear how upset their 4 year old has been about it.

Honour your father and your mother, as the LORD your God commanded you, that your days may be long, and that it may go well with you in the land that the LORD your God is giving you.
Deut 5:16

It was a stark reminder that there are a lot of sacrifices in moving to Africa (or India, or Iran, Wales, etc), and some of them will involve strain to relationships we have valued for years. There is an onus on us to appreciate the pain we are going to be causing others, and do what we can to minimise that distress.

Changing the world

dhThese notes are about the CMF Developing Health Course 2014.

The focus of today is Community Health. I made notes on the whole course in 2012 – you can read about this day here.

Each day I’m just going to write about things that impacted me, and things I need to read later…

An interesting morning

Ted LankesterTed Lankaster spoke first. Chatting to him at breakfast made me realise that we need to talk to InterHealth about vaccinations, because we leave in about 6 weeks now, and we still haven’t organised ours!

Some cool things he said:

Inverse care law: the availability of good medical care tends to vary inversely with the need for it in the population served. We are seduced by the west, and that leads to a paucity of doctors in the developin world.

One solution is task shifting – ensuring tasks are carried out by the least qualified person able to competently do it: you don’t have your doctor cleaning the bins in the hospital…

He also recommend we read some of the emails sent out by Jeffrey Sachs – who is the head honcho at the UN Sustainable Development agency. I will endeavour to read some, and maybe even blog about it…

Tanzania and change

Next up was a great personal account of living and working in Tanzania, from Irene McClure.

She shared the problems with clean water, where every time it rained the infectious disease goes crazy because of poo in the fields being washed into the water. Stopping the disease is easy with medication, but breaking the cycles of ill health is a whole different story.

Tippy tappies are a simple idea: an empty plastic bottle, hanging by the doorway, to remind people to improve hand hygeine before cooking. It’s an easy placement of reminder and opportunity to change. I wonder what lesson is there for us in something like that?

She recommended we read “Half the sky: how to change the world“, and left us with a final challenge:

Unless a vision is too big to be achieved by man,
its not from God.

If you want to do something and have no power to do it, it is povertyPoverty tutorial

Before lunch, Nick Henwood, led us in a challenging tutorial, about the difficulties of westerners going in and trying to solve everyone’s problems for them, how it feels to be on the “receiving” end of that “aid”.

One of the tutorials involved thinking about myself, looking at areas of myself. Self, spiritual, others, rest of creation. Many of the principles are lifted straight out of a book called “When Helping Hurts“, which I’ve bought Edit: And can HUGELY recommend as a book that anyone passionate about helping the poor in society should read.

For me, the course just, it just confirmed my thoughts about this course: I need to take some time to reflect. I don’t always need to achieve things: I’m using the next two weeks for peace, for reflection, for a deeper emotional learning than simply cramming more medical knowledge into my brain.

One thing Vicky said today was a wonderful mix of Christian and Medical that I love at CMF:

Fortunately prayer has a long halflife

I’m really seeing how the things God has been doing in our lives over the last year (and years) have been layers building up a bigger picture. Presumeably there’s minimal renal excretion of Holy Spirit…

Developing Health… again

CMF LogoTwo years ago, I went on the Christian Medical Fellowship “Developing Health” course. Its a two week, fairly intensive course, covering many topics relating to working in the developing world as a doctor. 

Last time I attended, I approached it firmly from the medical perspective, aiming to learn as much about the clinical challenges that I might face in Africa. I also wrote like 18,300 words on the subject, over 11 blog posts

The course (and CMF) takes a pretty holistic approach, not just trying to teach us how to sort diseases, but how to solve problems, in culture, in societies; in ourselves. What use is curing HIV, if you aren’t teaching people the value of stable, committed, loving relationships, and the role of sex within that?

I’ve decided to attend it again, before we go to South Africa in August. Katherine has come with me for the first 24 hours too.

I’m not going to blog as extensively this time around. I’ve got some great medical notes from a few years ago, and I will update them as needed, to give me an even more solid understanding of the science. But I’m going to sit back a little more, pray a little more, and focus on learning from others on the best way for me and Katherine to serve in Africa, and to nourish ourselves and our family at the same time.

Day One – Changing The World
Day Two – Good Mental Health
Day Three – Bugs, and passions that won’t let go
Day Four – HIV, Mission and Song
Day Five – Baby, baby (and other paediatrics)
Day Six – Joining bones (and mission partnerships)
Day Seven – The Cutting Edge…
Day Eight – The Ladies are Dying
Day Nine – Ladies, feet washing and goodbye curry
Day Ten – Snakebites and sad goodbyes

Evening Talk

The evening talk was from Kisiizi Hospital legend Ian Spillman. With decades of experience in Uganda he shares such a loving, clinically astute, Christ centred viewpoint on life.

There was lots he said that resonated. I find it annoying how many superfluous blood tests we do in the UK. He shared the story of a child with a Wilm’s tumour of the kidney: the patient was diagnosed, treated and discharged without having their blood electrolytes checked even once. In the UK, it wouldn’t have been surprising to hear over it being checked more than once a day.

Medicine really is crazily simple – it literally all comes down to:

  1. A careful history
  2. Thorough examination
  3. Appropriate investigations

Then you use a synthesis to reach a conclusion. I wonder if we need to try to do the same a little more with our lives:

  1. Reflect on our path: where God has taken us, where we are going.
  2. Examine ourselves: our heart, our passion, our motivations
  3. Appropriately seek guidance from others (and through prayer)

The end of Ian’s talk was a classic ridiculous coincidence that happens all the time in a lively walk with Jesus: it turned out his whole talk was based on a verse in Ephesians 1.

Is that really a coincidence? Well, our church is doing a preaching series on Ephesians all this month. We covered that passage in our cell group this week. Me and Katherine rarely take the time we should to sit down and study together – yet, for the first time in ages, I really felt I wanted to go deeper into it on Thursday night. So we spent half an hour studying Ephesians.

And then Ian just plucks the one passage that really spoke to me.

Just after I prayed last week that God would give me a passage to lean on, to trust in, as we take a trip to Africa.

I pray that the eyes of your heart may be enlightened in order that you may know the hope to which he has called you, the riches of his glorious inheritance in his holy people, and his incomparably great power for us who believe.
Ephesians 1:18-19

I pray, over the next two weeks and beyond, that the eyes of our hearts may be enlightened.

Three, One, Twenty Eight & Two Thousand.

Dear God,

This is an amazing week for me:

High five with JoenI can tell this period is going to be a period of introspection for me each year. A time where I weigh up my behaviour, my goals, my achievements and my failures. Is my character where I want it to be? Is it where You want it to be? Is our relationship where it should be?

I’m not going to write everything here Lord: much of that needs to be just between me and You, but I felt led to share a little of this.

There was a promise I made to Katherine, 5 years and 5 months ago, and there were words to that promise.

Do you promise to love, cherish and submit to Katherine?
I do.

Now, at the measured time in our lives, I pray you help our family to fulfil that promise.

Neriah and Joen on a walk

Help us to love one another. Help us to love You, and show love to others outside our family. Help that love wrap round us and define our family – “The Lowrys? Oh, don’t they just love!”

Help us to cherish. As I sat at the dinner table, watching Joen pretending to eat Quorn with a fork, whilst actually surreptitiously feeding Heze and Pudding under the table, as I watched Neriah bite into a brussels sprout and simultaneously look surprised, happy, disgusted and also manage to kick her legs, my heart jumped. I feel like any moment not spent sitting watching them sleep is one wasted, but yet I know I probably spend more time looking at facebook each day than I do into their eyes. Help us to reboot our addictions: let’s be consumed by one another, not by things that fade away.

Help us to submit. When Joen tells me to “shut up”, help him to realise that his 3 minutes in “Time Out” is a time for thought and repentence. Help me to submit to him, to listen to the fact he is telling me to “shut up” because I’m not giving him the attention and validation he craves. Help me to submit to Katherine, when she wants the cup of tea without asking for it. Help her to submit to me, when I need to spend some time on the computer, not dealing with any of our children. Help Neriah, as she starts to discover and demonstrate her free will for the first time, help her to get it more right than I ever have. Help us all fall over one another in selflessness, and give us the strength to know when we need others to serve us.

When we get to this point next year Lord, help us look at that promise, and feel able to say “I did!”.

Love, Your obedient, disobedient, friendly, distant, unworthy, worthy son,
Chris