Lent, Early Rising, and Footwashing

This past Wednesday was Ash Wednesday, the beginning of Lent for Latin Rite Catholics.  Lent is an observance of 40 days prior to the Easter Triduum beginning on Holy Thursday.  For most modern westerners, Lent does not seem so different from the rest of the year, although regular Mass attendees will notice liturgical changes such as violet vestments, an emphasis on mercy and penitence (“For Christ came not into the world to condemn the world, but that the world might be saved.”), and the absence of the Gloria and Alleluia’s.   Even not-so-observant Catholics often choose to “give up something for Lent,” even if they do not choose to participate in the community activities of fasting on Ash Wednesday and Good Friday and abstinence from eating meat on Fridays.   This practice of giving up something, often something symbolic such as chocolate or desserts, invites us to practice a mild asceticism as we recall the significant asceticism of Jesus (“foxes have dens and birds have nests but the Son of Man has nowhere to lie his head”), and prepare to remember his death for our salvation followed by his triumphant resurrection.

 

This year, I decided that one of my Lenten observances would be to participate with the community in Morning Prayer, from the Divine Office, each day.  This begins around 5:15 AM.  On Thursday, after congratulating myself for this effort, I was awakened by the church bell ringing at the parish, which normally rings at 5:30 AM.  Startled to alertness, thinking I had overslept, I checked the time and it was 4:22 AM.  It seems that during Lent here, the parishioners pray the Stations of the Cross before 6:30 Mass.

Footwashing

On Holy Thursday, all Masses while recalling the Jewish Passover feast, include a ceremony of Washing of Feet.  This recalls the events related in the 13th chapter of the Gospel of John.  Prior to seating for the meal,

3 Jesus knew that the Father had put all things under his power, and that he had come from God and was returning to God; 4 so he got up from the meal, took off his outer clothing, and wrapped a towel around his waist. 5 After that, he poured water into a basin and began to wash his disciples’ feet, drying them with the towel that was wrapped around him.

The significance of this is not at all obvious in our American culture.  For meals, we sit in chairs, at tables with our feet, usually in shoes, underneath the table and far from the food and from our neighbors.  It is unusual for our feet to be so dirty that they would require washing before entering the dining area.  For the ceremony of footwashing at Mass, there are usually representatives, rinsing of one foot only, and certainly most people make certain that their feet are clean and healthy before they are approached by Father!  Even so, many people find participating in this to be difficult.  We are not used to anyone bathing us, even our feet.

In the culture of Jesus, people sat on cushions near the floor to eat, and their feet were much closer to the food and to each other.  People wore sandals as they walked the dusty roads.  Prior to living in Cameroon, I had no idea what this really meant.  Here, most of the roads are unpaved and during the dry season there are several centimeters of dust on the road.  Given that there are goats and chickens roaming freely, I do not need to describe what might be in this dust.  Returning from any kind of walk wearing anything but heavy boots (too hot) means that one’s feet are caked in reddish brown dirt.  Even after careful cleansing with a brush it is not uncommon for us to find that we have missed streaks or a whole area, much less the difficulty of cleaning toes and toenails.  It is easy to imagine that wealthy people in Jesus’ culture might have had a servant to clean the feet of the owner and his guests.  Remember that water must be brought to the site of use – no shower or running water, warmed if desired (requires carrying firewood), and then poured manually if rinsing is desired.  The scripture does not describe the degree to which Jesus cleaned the feet of his guests.  We do not know if each person had fresh water or if there was soap.  We do not know how Jesus cleaned himself after this task.  It is now clear to me, however, just from trying to keep my own feet suitable for being in my quarters, that cleaning the feet of 12 grown men who have been out in the dust in sandals, would have been a real task.  We are taught this humility by Jesus.

6   He came to Simon Peter, who said to him, “Lord, are you going to wash my feet?”

7   Jesus replied, “You do not realize now what I am doing, but later you will understand.”

8   “No,” said Peter, “you shall never wash my feet.”
Jesus answered, “Unless I wash you, you have no part with me.”

9  “Then, Lord,” Simon Peter replied, “not just my feet but my hands and my head as well!”

10   Jesus answered, “Those who have had a bath need only to wash their feet; their whole body is clean. And you are clean, though not every one of you.”

11 For he knew who was going to betray him, and that was why he said not every one was clean.

12  When he had finished washing their feet, he put on his clothes and returned to his place. “Do you understand what I have done for you?” he asked them.

13  “You call me ‘Teacher’ and ‘Lord,’ and rightly so, for that is what I am.

14  Now that I, your Lord and Teacher, have washed your feet, you also should wash one another’s feet.

15  I have set you an example that you should do as I have done for you.

16  Very truly I tell you, no servant is greater than his master, nor is a messenger greater than the one who sent him.

17  Now that you know these things, you will be blessed if you do them.

Welcome to 2016

Since I have recently learned that some people actually read my blog, I thought I should finally write something again.

I arrived here again a little over a week ago.  We were able to complete two open heart surgeries last week, one for rheumatic valvular disease and the other for a woman who had likely had endocarditis in the fall.  Both women are doing well and have been transferred out of the ICU and to the recovery ward.  Dr. Cabral also was able to place a pacemaker/defibrillator.  We continue to have delays related to availability of rare blood types.  The blood bank works hard to maintain a list of donors for patients with these blood types, but of course donors also need their own blood!  We continue to work toward improving this system, and we are grateful to our generous regular blood donors.

For those new readers, I invite you to review the archived blog posts.  These posts review many of the things that we do here in Shisong and introduce some of our many projects and collaborators.  I particularly invite you to visit my initial post here:  http://shisongheartcall.blogspot.com/2013/10/cameroon-2013.html

As I read it, only a couple of things have changed.  As you can see, after my initial 6 month stay, my subsequent visits have been shorter but more frequent. 

Prayer requests:  for those readers who pray, please consider praying for our current patients, particularly those awaiting funding from our current fundraiser (see December 2015 post), and for the Horne and BurketThoene families who are ending their service here in Cameroon this year and discerning their plans for returning to the US.

From today’s liturgy:
          Jesus proclaimed the Good News of the kingdom
          and cured all kinds of sickness among the people.
          Alleluia!

Merry Christmas

I returned from Shisong on December 4 and will return there early in 2016.  We were able to complete 12 open heart surgeries in addition to those congenital operations performed by the San Donato Mission in November.  Our patient population remains extremely dependent on external sponsorship to make surgery available for poor patients.  I am particularly grateful to Fr. Herald Brock of Franciscan Mission Outreach and the team from Mi-Do for their commitment to fundraising to sponsor patients who need non-congenital heart surgery.  Please see below for our current group of patients awaiting funding and if you are among my readers who pray, pray for us and these patients.

Franciscan Mission Outreach December 2015 Activity Report View this email in your browser FMO 2015 CAMEROON CHRISTMAS APPEAL HONDURAS: Aug 4 - Sep 5 and Nov 3 - Dec 3, 2015 There’s always a lot going on in Honduras when Fr. Herald is there: Masses, Confessions, Annointings, First Communions, retreats and talks to different groups (Christian Family Movement, married couples, children and youth, lay missionaries, Catholic University students and personnel), mission visits to outlying communities… All with the goal of building up the Body of Christ in this mission setting. UPCOMING EVENTS: 5-9 Dec 2015: Parish Mission, Corpus Christi, South River, NJ  2-9 Jan 2016: Friar Suppliers Haiti Mission Trip 20 Jan-11 Feb 2016: Honduras 13-17 Feb 2016: Parish Mission, St. Faustina, Clermont, FL 20-24 Feb 2016: Parish Mission, St. Louis, Alexandria, VA 27 Feb - 2 Mar 2016: Parish Mission, St. Anthony, S. Pines, NC 20-24 Mar 2016: Jesús en la Playa, Honduras Our missionary efforts depend on your spiritual and financial support. Please pray for us! Tax-deductible donations to support the life, ministries and missionary outreach of the Franciscan Friars of the Renewal can be made online by clicking on the link below: Donations can also be made by check to the order of : “Franciscan Mission Outreach” and sent to : Franciscan Mission Outreach  PO Box 1086  Secaucus, NJ 07096-1086  *Please indicate if your donation is intended for Cameroon. Tel:  718-618-4511 Fax: 201-667-2801  Thank you! You are in our prayers! Facebook Share Forward

This email was sent to emdailor@gmail.com  why did I get this?    unsubscribe from this list    update subscription preferences  Franciscan Mission Outreach · PO Box 1086 · Secaucus, NJ 07096 · USA

Africa is Not a Country, continued and 100 cases

The Cardiac Centre is hoping to complete 100 cardiac operations this year.  Approximately half of these will have been completed by the teams from Europe and Mozambique that provide congenital cardiac surgery, with a large proportion of funding from Cuore Fratello and other groups.  The remainder are “adult cases”, meaning not congenital although many of the patients are young people, with rheumatic disease, performed by the local team and visiting anesthesiologists.  This year Dr. Maurizio Meme was here for 6 months and together with Dr. Charles Mvondo and the local team completed approximately 36 cases.  I was here in February and will be here until December.  Dr. Italo Milocco was here in January and September, working with the Mozambique team while Dr. Mvondo sought additional education and training in Leuven, Belgium.  We have completed 5 cases and the first patient was discharged on Friday on post-op day 10. (See photo below with the patient next to Dr. Charles in the center).  The Italian mission team from San Donato will arrive next week and we expect them to complete 13-15 cases.  We have patients in the ward awaiting treatment of conditions not related to their cardiac conditions before proceeding with their cardiac operations.  Unlike in the US, it is difficult to fully evaluate patients before they arrive for their operations.  They often come from long distances and are unable to incur the expense of pre-operative evaluation until the procedure is actually scheduled.  This means that unexpected findings lead to delays in proceeding with surgery.  “Unexpected findings” can include something as simple as a rare blood type, meaning that we are unlikely to have the patient’s blood type readily available and need to seek it locally or import it from the cities.
 

Working with Dr. Charles for the 6 month period beginning in October is Dr. Marta Pugliese, a cardiothoracic surgery resident from Rome.  Below you see Dr. Mvondo discussing a complex aortic case with the team and Dr. Pugliese displaying her notes resulting from that discussion.
 

 

I came across this reflection from a Ugandan journalist titled “Why I Cannot Tell the African Story.”  She describes the many situations of Africa and how they cannot be distilled into a brief summary.  Even within the US we have various cultures, economic scenarios, and even languages.  How much more so in Africa!

http://www.bbc.com/news/world-africa-34508552
 
Sunday November 1 was All Saints Day.  The Gospel reading included what we call the Beatitudes:

THE BEATITUDES
Blessed are the poor in spirit, for theirs is the kingdom of heaven.
Blessed are they who mourn, for they will be comforted.
Blessed are the meek, for they will inherit the land.
Blessed are they who hunger and thirst for righteousness, for they will be satisfied.
Blessed are the merciful, for they will be shown mercy.
Blessed are the clean of heart, for they will see God.
Blessed are the peacemakers, for they will be called children of God.
Blessed are they who are persecuted for the sake of righteousness, for theirs is the kingdom of heaven.
Blessed are you when they insult you and persecute you and utter every kind of evil against you [falsely] because of me.  Rejoice and be glad, for your reward will be great in heaven.  Thus they persecuted the prophets who were before you.
 

Next time I would like to share some updates on the Lifebox program (www.Lifebox.org).

Home Sweet Home

Greetings from Shisong and my apologies for being so delinquent about posting to this blog!

I arrived in Shisong on October 8 after leaving Rochester on the 5th.   There have been some delays in performing surgery, so I have been catching up on other work and projects.  Sr. Jethro was in the US over the summer making connections with Cameroonians here and with Americans interested in the work of the Cardiac Centre.  We were talking by phone and she laughed when she accidentally referred to me coming “home” to Shisong.  In many ways, though, it is another home for me.

I arrived near the end of the rainy season.  It is lovely to see everything so green.  There are some students from the north of Italy and I went with them to the waterfall which I show below with much water!  In the picture are Gonas Mayr and Alicia Adajar-Duante.  Alicia is a Lay Mission Helper; she is a critical care nurse from California who will be here at the Cardiac Centre for three years.  Her blog is here: http://aliciaincameroon.blogspot.com/
 

 

 

While I was preparing to return to Cameroon, I was working on preparing several responsibilities that I have in Rochester for me to be able to manage long-distance or for others to be able to manage.  In the midst of this, I came across this story describing a tremendous act of generosity.  So many of the stories about troubled areas describe acts of unspeakable cruelty or at best stories of indifference to suffering.  Yet among the poor and struggling, generous acts like this occur daily.  It is good for us to be inspired (and humbled) by stories like this.  (http://www.cbsnews.com/news/young-nurse-adopts-newborn-he-had-no-one-else/)  This man encountered a dying woman and her newborn son.  He only owed them medical care, and for that they were rapidly transferred elsewhere, yet responded by offering the baby a family.  Nurses who are employed in Sierra Leone might be financially better off than some others, but they are hardly wealthy.  Anyone in a community such as his that has any money is instantly tapped to support many others.  It is acts such as this that remind me that I have much more to give.

February 2015

I arrived here in Shisong on February 1, and had a couple of days to relax and see people since the surgeon, Dr. Charles Mvondo, had to be at an appointment in Italy.  We began operations on Wednesday, February 4 and the work has been steady.  In the past, some people have suggested that I say more about the patients that we care for.  I have been reluctant to say much about my patients due to their right to confidentiality and privacy.  Some of the patients have agreed to have their pictures posted on the Cardiac Centre website and I have referred people there for more specifics.  However, as readers of this blog have seen, this year there was a very successful fundraiser for sponsorship of several patients.  Mi-Do (www.Mi-Do.org), run by the amazing team of Dr. Claudia von Lutterotti and Andrea Maria Zeller, has been incredibly successful at raising sponsorship funds since their inception a little over a year ago.  Fr. Herald Joseph Brock, CFR, with Franciscan Mission Outreach (https://www.facebook.com/franciscanmissionoutreach), joined forces with them prior to Christmas to advance fundraising in the US for this very special project.

Donations to this project can still be made at either of the above sites or here:  http://www.youcaring.com/nonprofits/a-heart-for-cameroon/262505


These are the patients that were listed for the FMO/Mi-Do fundraiser.

I met all of these patients here during this trip, and we were able to operate on several of them, and the others will be cared for by the congenital team next week.  I am frequently inspired by my patients, particularly here in Shisong.  These patients are very happy to be having their operations.  One patient the other day was escorted to the OR by two previous patients who were recovering on the ward!  I also witnessed one patient who was in the hospital awaiting the results of her testing prior to surgery sitting with the family of a patient who had died.

Thank you from the bottom of my heart and on behalf of our patients for all of the support and financial gifts.

These post-op patients and guardians (theirs and others) were sitting outside yesterday:

Congress

Saturday was the 2nd Annual Congress of the Cameroon Northwest Anaesthetist Association.  It was well-attended by over 90 anesthetists, theater staff, and nursing students of the hospitals and health centers of the Northwest Region as well as the Western Region.  There was a Lifebox distribution and training program, as well as instruction and training on the WHO Surgery Safety Checklist.  There were also specialty lectures and discussions.  Overall I think this is a successful organization that represents the commitment to excellence and ongoing improvement of Cameroonian nurse anaesthetists.

Globalization of Indifference

Sunday was the First Sunday of Lent and the letter from Pope Francis for Lent, 2015 (“Make your hearts firm,“ Jas 5:8) was presented.  Pope Francis is concerned about what he is calling the “Globalization of Indifference.”  His idea is that when we are healthy and comfortable, we fail to think about those who are suffering.  In America, with the 24/7 News Cycle, we can sometimes feel overwhelmed by the problems of the world and within our nation, and it is easy to try to push this away and exist in our healthy and comfortable environment.  One way to overcome this sense of feeling overwhelmed is to focus on one or 2 things.  This is not to be indifferent to the rest of the suffering, but to realize that most of us are not in a position to correct all of the world’s injustices – but not to unduly contribute to them either!  Let’s not let the sense that we cannot fix everything lead us to indifference and selfishness so that we do not try to be part of the solution of anything.

The letter can be found here: http://w2.vatican.va/content/francesco/en/messages/lent/documents/papa-francesco_20141004_messaggio-quaresima2015.html

Happy Lent!

Much Progress with Sponsoring Patients! Please Consider Helping.

Merry Christmas!  I love this season and this year once again am so grateful for many things.  I wanted to show the great work that Fr. Herald and MiDo have done in getting patients their much needed heart surgery in Cameroon.  Below is Fr. Herald's Christmas Newsletter with a link to a donation website.  I will be headed back there in a few weeks and we hope to operate on these patients.

Peace and Happy New Year!

Franciscan Mission Outreach December 2014 Activity Report

 

A HEART FOR CAMEROON
From October 15 to 24 Fr. Herald accompanied US cardiac anesthesiologist Dr. Ellen Dailor (top right) to the Cardiac Centre at St. Elizabeth Hospital, Shisong Cameroon, run by Franciscan Sisters. Dr. Dailor has served several times at this state-of-the-art medical facility - the only one of its kind in Central Africa - and shared her experiences with Fr. Herald. He went to see how Franciscan Mission Outreach might help provide life-saving heart surgery to Cameroonians in need. By God’s providence, Dr. Claudia von Lutterotti and Andrea Maria Zeller (below left, with Fr. Herald) of the European nonprofit Mido - which raises funds for the same purpose - were also visiting at the same time.

Cameroon is a developing country of 22 million, a vast number of whom live in rural areas, survive on what they grow and lack adequate medical care. The average yearly income is under $2000 and life expectancy reaches only into the mid-50s. Cameroon has an extremely high incidence of rheumatic heart disease: 100-200 times higher than in wealthier countries. Rheumatic heart disease (caused by the strep virus) damages heart valves, affects mostly children and young adults and is the most common cause of cardiovascular death in the region. It’s estimated that 40,000 people in Cameroon suffer from this disease.

The Cardiac Centre at St. Elizabeth Hospital has the  advanced capacity to do open-heart valve replacement surgery to treat this disease and save lives. The Centre has a full time, European trained Cameroonian cardiac surgeon, Dr. Charles Mve Mvondo (right), and the staff and technology to provide intensive pre- and post-operative care. When Dr. Dailor is there the surgical team is complete. Though the cost of this surgery in Cameroon ($7000) is only a small fraction of that in the US, it far exceeds the means of almost everyone there who needs it. Nearly 100 patients unable to pay are on a waiting list for surgery.

That’s where Franciscan Mission Outreach comes in. We are working with the Live Greater Foundation to match donations from Mido and cosponsor patients for heart surgery at which Dr. Dailor will attend as anesthesiologist. We are endeavoring to make sure this amazing Cardiac Centre functions at full capacity for the benefit of the poor. Our goal is to raise $25,000 to give seven Cameroonians in need the Christmas gift of free heart surgery.

Please help us in this effort to save a life!
Visit: www.youcaring.com/fmo-h4c

No Ebola Here!

You have to live under a rock not to know that there is an ebola outbreak in West Africa, an outbreak that is leading to tremendous fear and suffering.  By West Africa, I mean in Liberia, Sierra Leone, and Guinea.  When Dr. Falan Mouton gives presentations on Lifebox in Africa, she likes to display an image like this:

In this image, Liberia, Sierra Leone, and Guinea are generally in the area of Southern California, and Cameroon is essentially in the area that would be south of eastern Texas.  One concerned colleague pointed out that it is “only a plane ride away.”  This is true, but it is also true that if people from West Africa get in a plane, it is more likely to be going to Europe or the US than to Cameroon.  More importantly, the people who are suffering from Ebola Virus Disease are not very likely to get into a commercial airplane, since most of them are too poor to afford an extravagance such as this.

Nevertheless, ebola fear is in full swing and while the Europeans and Americans that I met during my trip to Cameroon were happy to be there advancing our projects, several groups have also cancelled out of fear of ebola.  I am sorry that children in Cameroon will be dying of cardiac disease because children in Liberia are dying of ebola.

Although Ebola Virus Disease is serious and scary, and should be respected, I submit a few observations for perspective.  While I was in Cameroon, no Americans died from Ebola Virus Disease.  (The only Americans who have acquired EVD are those who have directly cared for victims of EVD.  This is generally true of West Africans as well.)  While I was in Cameroon, several Americans died in school shootings and in apparently random highway shooting violence.  It appears that I am still much more likely to get the flu, and die from it, than to get EVD.  I might point out that I have been vaccinated against the flu, and many people I know refuse this vaccine.  For my part, I would like to strongly recommend that we support those trying to treat this terrible problem in the way that we support people in other natural disasters, and avoid treating victims like criminals.

Doings in the absence of Ebola

I returned from Shisong Saturday evening, and I cannot call this trip anything but resoundingly successful.  I was there for 12 working days, and we completed 10 open heart surgeries and 5 pediatric interventional catheterization cases.  These patients ranged from age 10-49 and all of the cases were double valve repair/replacement except for one that was for replacement of aortic valve and ascending aorta and proximal aortic arch.  As of the time I left, all but one patient had been discharged from the ICU and 2 were preparing for discharge from the hospital.  Almost all of the patients were sponsored, at least to a significant degree, by one of the various organizations that I have discussed here in the past.  In particular, Mi-Do has done a phenomenal job of raising funds for both pediatric and adult patients who need cardiac surgery.

There were a variety of visitors and rotating physicians around the cardiac center.  There is a General Practice physician interested in cardiac surgery, and there were 3 cardiology residents rotating at the center for 2 months.  We were able to discuss cardiac surgical issues as well as increase their experience in transesophageal echocardiography.

 

In addition to the successful surgical mission, Fr. Herald Brock, CFR, of Franciscan Mission Outreach (https://www.facebook.com/franciscanmissionoutreach - there are pictures) visited the Cardiac Centre to evaluate options for further fundraising to sponsor patients for surgery and connect the Centre with organizations that can help to acquire funds for equipment and supplies such as heart valves.  I do believe that it was providential that the Mi-Do staff were there at the same time.  It was a great thing for Fr. Herald to meet with Andrea Marie and Claudia to discuss opportunities for partnership and allowing the poorest of the poor to have necessary surgical care.  I expect to have further detail on this soon.

Finally, I was blessed to have excellent timing for this trip in another way.  Both Eric and Logan Horne and Tanjong Benson and Emma had their babies (Gabriel and Cindy Trina) just before I left.  Everyone is healthy.

News!

So I arrived in Rochester at the end of March and never quite got around to posting at that time.  Now that I am preparing to return, I thought it was time for an update.  Besides there is so much to share!

I knew that leaving Shisong would be difficult, but it is not easy to describe that in a blog post.   The last week there was busy.  We operated on six patients, all of whom were doing well at last report.  One woman came from Nigeria after having been refused surgery in Dubai.  Moving back home and into my job here went fairly smoothly, but processing my time in Shisong was a little more challenging.  My thanks to all who are so supportive both while I am there and while I am here.

Sister Jethro and Doctor Sister Helen were in the US for 3 weeks in July and August to attend the Cameroonian Professional Society annual meeting in Houston on August 1-2.  They spent time in Lacrosse, WI on July 20, spend 2 days in Rochester on July 28 and 29 where they visited the University of Rochester Medical Center and spoke at my home parish of St. Marianne Cope in Rush, NY, then on to Houston and Dallas, and finally to Washington, DC.  Please pray that the many contacts that they made lead to collaborators in advancing cardiac care in Africa and serving the poor.  Unfortunately, I forgot to take any pictures of them speaking in Rochester but here they are at Niagara Falls where we made a brief stop:

In October, I will spend about 2.5 weeks in Shisong giving anesthesia for cardiac surgery.  Fr. Herald Brock, CFR, from the Franciscan Friars of the Renewal, will also visit the Cardiac Centre during this time.  We are hoping that Franciscan Mission Outreach will be able to assist us in fundraising to improve the access of cardiac surgery to the poor in Cameroon and the surrounding area.  Fr. Herald has done much work with the poor in Honduras and in what is now South Sudan, and we are very grateful for his support of this work in Shisong.  You can visit him on Facebook here: https://www.facebook.com/franciscanmissionoutreach.

Lent

Last Wednesday was Ash Wednesday, the beginning of Lent.  Even non-Catholics, nominal Catholics, and no-longer-Catholics often have some sense or memory of observing this desert period prior to Easter.  Many of us recall as children practicing or still practice “giving something up for Lent.”  Sometimes it is something easy and specific, like chocolate milk.  Sometimes it is more challenging like sweets or television.  More recently, we have been encouraged to adopt a penitential positive practice during Lent.  Often, though, the purpose of such a practice, in combination with other Lenten observances such as abstinence from meat on Fridays, fasting on Ash Wednesday and Good Friday, and receiving ashes on Ash Wednesday, is unclear.  Two goals of the sacrifice are to recall the sacrifice of Christ and to promote holiness in one’s own life.  How, then, does this work?  The practice of asceticism as part of a pathway to holiness is very ancient and found in many cultures.  Detachment from materialism and slavery to our bodies is widely recognized as promoting the spiritual life.  An act of discipline also promotes the spiritual life.  Of course these things can be and have been overdone, but in our culture my impression is that overdoing it is rare and the risk of underdoing is much greater.  This is not to say that a legalistic approach or trivial approach is useful, although I think that any attention to the spiritual life is better than neglect, given the secularism of our age.  The fear of hypocrisy is often used as a rationalization for neglect of one’s interior life or for failure to observe the work of God in our lives.  Another rationalization for refusing to observe Lent is a failure.  It can be easy to forget a Lenten promise, then on remembering, to give up rather than recommitting and moving on.  Obviously this undermines the discipline that was intended by taking on the practice in the first place.

I have found the observance of Lent to be a great spiritual opportunity.  It is long enough to develop a new habit but short enough to maintain discipline if the promise is difficult and not meant to be adopted for life.  The external observances and reminders are supportive of the Lenten practice, and one’s friends can also be supportive during this time.  Some things that I have done over the years as Lenten practices have included: A daily rosary, fasting on Friday mornings, giving up meat and fish for the entire period of Lent, giving up mindless television while not giving up all television, and adding night prayer to my daily routine.  I have not always been successful at my Lenten plan, and sometimes have even abandoned the original idea after realizing that it really was not useful.  Even though I do not eat much meat, giving up meat and fish completely turns out to be difficult to remember, especially when attending meetings where the food is served and on Saturdays following a Friday when abstaining from meat is already required.  Once I tried to give up computer solitaire, and discovered that playing solitaire helped me to think about other things and I was having trouble concentrating.  Night prayer also turned out to be difficult to remember to do since it was not a habit and required on-going reorientation.  On the other hand, some practices have been overwhelmingly successful at revitalizing my interior life.  The year that I pledged to pray the rosary every day kick-started a daily prayer time that I had previously been unable to maintain.  Although I have varied this practice since then, I credit that Lent to the prayer life that I have now and to many decisions that have been made since.  A short period of fasting turns out to be useful at focusing on the poor and at connecting with the ancient spirituality of Christianity.

It took me a while to get this posted, but it is not to late to consider a more serious observance of Lent if you have not already done so.

From Todays Liturgy:
O Lord, you have been our refuge, from generation to generation; from age to age, you are. (Cf. Ps 90:1-2)

True Religion?

The Mass readings these weeks have been from the book of James, who has a lot to say about what it means to live our Christian faith.  One of the things that is inescapable in Shisong is the degree to which religion (not only Catholicism) permeates the culture, and the fervency and apparent joy with which it is observed.  One of the visitors that I have spent time with in Shisong doubted the faith of many of the people here.  This individual felt that much of the fervency and enthusiasm expressed in the Catholic community was based on the culture and behavioral expectations rather than true love of Christ or belief in God.  In her country, the cultural aspects of faith have largely disappeared, but she feels that those that practice their Catholicism are sincere because those without faith simply don’t bother.

Being here for 5 months certainly does not make me an expert on anything, and I am not inclined to judge the faith of individuals or a community in any case.  However, it could be interesting to share a few observations.  I think that nominal faith and participating in a faith community for social reasons exists everywhere and in every faith and philosophy.  Even in countries where there is severe persecution it is possible that people seek martyrdom for the wrong reasons, although you might suspect that there is less “acting” in a community where the faith costs much.  In Shisong, the Catholic community is served by Capuchins (Franciscan friars), as well as diocesan priests from Kumbo.  I have heard teaching at high levels to general audiences (homilies and instructional settings) on Christian living, the differences between superstition and sacramentals, the tension between one’s Christian faith and the traditional practices of one’s community or position, Christian sexual morality, and care for the poor.  The Mass attendance for the hospital weekday Masses on Wednesdays and Fridays is high; for some it is certainly that they are attending to say they have attended because they work in a Catholic hospital.   However, the level of participation within the Mass is high and I think it would be unreasonable to suspect the motives of most of the people.  In any case, it is much easier for people to be exposed to Christ and to come to a true knowledge of Him in this setting than in a secular setting where Christianity is routinely disparaged, misrepresented, or absent.  A tailor I have worked with does not work on Sundays and leaves early on Saturdays to go to Bible study (and yes, she is Catholic).  Some of the nurses in the operating room belong to various men’s groups that study the faith together as well as serve the community; these activities take a great deal of time – more than activities in America usually expect.  Obviously the sisters dedicate significant time to prayer, study, and service, feeding not only their own faith but also the faith of others.

On the downside, one of the most disturbing stories I have heard came out of Central Africa on the BBC.  The BBC has no love for Christianity and may well have been trying to present “Christians” in the worst possible light.  There have been stories of extreme generosity and Christian heroism from the CAR as well.  However, in this story, people identified by the BBC as “Christians” were participating in clearly un-Christian behavior.  All Christians choose wrongly sometimes, but only rarely is the wrong behavior intentionally identified with our Christianity.  I do not know if the men in the news story identified themselves as Christians, or if to the BBC reporter, any non-Muslim could be identified as a Christian.  These men were seeking revenge against a Muslim man for atrocities committed against Christians by other Muslims (not this man).  Not only did they desire revenge, but they identified it as an obligation.  Additionally, they were described as wearing amulets which would protect them from harm.  In no aspect of the story did God or Christ have anything to do with their behavior or their motivations.  It is possible that these people had had some exposure to Christianity, but clearly their behavior in this story was not related to their Christian lives.  It would be better if the BBC would simply describe “ethnic violence” rather than to portray this as a religious war.  There are true Christians suffering in the CAR, and probably there are people of traditional religions suffering in the CAR, and there are a few Muslims remaining who are suffering in the CAR, and many refugees from the CAR in other places.  Please pray for all of them; I see little of this in the American news, although if you are praying for Syria you can just add the CAR.

The press has a tendency to present Catholicism as ridiculous.  If I learned about the Church and her doings from the New York Times I certainly might think that the Catholic Church is ridiculous.  It is important not to learn about Christianity from the mainstream press, which has its own agendae (primarily selling advertising, but there are others).  There is much rich and beautiful writing to help us understand the life Christ offers and the grace found through the Church.  In much of Africa, books and the internet are not readily available, so people learn about and celebrate Christianity in many other ways, including cultural practices and beauty.  It is not easy, or necessary, to judge.

From Today’s Liturgy:
I will recount all your wonders, I will rejoice in you and be glad, and sing psalms to your name, O Most High.  Ps 9:2-3

Cardiac Center vs. the Hospital

Although sometimes this sounds like political infighting, yesterday it referred to a sporting event.  The men of the Cardiac Center took on the men of the Hospital in volleyball and football (soccer), while the women challenged in a handball match.  I had not been asked to play, but on my arrival to watch was informed (begged) that I should go and change since the women’s team for the Cardiac Center did not have enough players.  I agreed to this, since I thought that we were playing volleyball!  I ended up on a handball team – a sport that I had never even heard of, much less played before.  These women were serious, and somehow the Cardiac Center won despite having me on their team (we also had to adopt a couple of hospital staff to make the team complete).  It turns out that handball is quite popular in Africa as well as in eastern countries.  Fortunately, there is a Wikipedia article about it so that after I was finished playing I could find out what I was supposed to be doing.  Actually, the game is not so complicated, but there are rules and it would probably be good to know them ahead of time.  You know, like whether you can run with the ball or not.  You (and Sr. Jethro) will be relieved to know that I suffered no serious injuries.  The men split their games, with the Hospital taking the volleyball tournament (wearing yellow) and the Cardiac Center winning the football game (in white).  As far as I can tell, a good time was had by all.

Clinical Judgment

In the beginning of medical school, we learned the scientific and humanistic foundations of medical practice.  It isn’t far into medical school, however, before students are introduced to “clinical judgment.”  I think of this as the decision-making process used to decide on a course of action based on the information available, which is always incomplete.  Even within well-studied conditions, it is not possible to know with certainty to which population of patients the person in front of you belongs, and even if the diagnosis is certain, the response to treatment might not be.  Add to this the necessary cost-analysis and the inherent conflicts of interest, and the practice of medicine can suddenly become quite challenging.  Usually within one’s own practice, a physician becomes accustomed to the various considerations that are required, so that only the rare patient is enough out of the ordinary to require extensive additional concern.  In the US, it is likely that your patient is actually in a population that has been studied, that any relevant guidelines apply to him or her, and that if you are wrong you will have an opportunity to follow through with another decision.

Although western physicians have contributed greatly to the care of the poor in developing countries through mission teams and individual efforts, I have always found this judgment issue to be quite challenging in a new location and culture.  It is difficult on a short-term basis to know what options the patient has available, what the risks are in that patient for the procedure or treatment that you want to give (given the differences in equipment, sterilization, and so forth), and how complications will be addressed.  Here in Shisong, we have the opportunity to provide, in many ways, “first-world” medical care to cardiac patients on a long-term basis; yet the judgment issues remain challenging and the uncertainty, while not paralyzing, is disconcerting at best.  In western countries, rheumatic heart disease is not defeated but it is rare, and to see severe rheumatic disease in a very young person is nearly unheard of.  [This is the point at which the issue of prevention is usually raised.  Everyone who treats advanced rheumatic disease in developing countries is aware that the problem should be preventable.  How to prevent it in this cultural setting is less obvious, and in the meantime it does not seem appropriate to refuse to treat the patients in whom the disease has not been prevented.]
 

Dr. Mve Mvondo and I have written an article for submission to a journal which addresses the issue of repair vs. replacement of diseased mitral valves in sub-Saharan Africa.  Although the article addresses primarily the treatment of mitral valve regurgitation, several of the concerns are general.  I outline a few of them here for your understanding (for my non-medical readers, some of these are not unique to Africa and apply to the decision-making process in our own lives in the US, especially if you have faced a rare disease or a treatment not covered by insurance).  Most of the patients who present for surgery are young (between 10 and 30).  Patients who are young who require valve replacement almost always receive a mechanical valve, because their durability is much better than current tissue valves.  There are several issues associated with living with a mechanical valve, but the most important one is the need for anticoagulation.  Lifelong anticoagulation is necessary to prevent strokes and to maintain valve function.  In the US, this is a burden because of the need for on-going monitoring as well as the risk for bleeding.  Athletes and people with high-risk jobs occasionally refuse this treatment rather than change their lifestyle.  Although there are modern valves which might require less anticoagulation, it is not yet certain that it is safe to forego anticoagulation in most circumstances.  Here in Cameroon, there are numerous additional considerations to subjecting a patient to lifelong coagulation.  First is the understanding of the patient that this is a necessary commitment.  It is not uncommon for a patient to stop their medication because they decided that it was unnecessary.  Another consideration is cost; neither the medication nor the monitoring is free, and most patients do not have insurance or much money.   The need for many patients to travel long distances to get their medication and monitoring also impedes successful therapy for many people.  Even where there are roads, most people do not own cars, and travel is also not free or easy.  Pregnancy is an important issue for many of these patients.  It is possible for many women to safely bear children, but it requires intensive prenatal care, careful drug management, and hospital delivery because of the risk of bleeding as well as the underlying poor cardiac function present in many of these young women.  This is a culture in which bearing several children is desired and expected.  Recommending against this is difficult, and in many cases impractical, so even if a patient agrees with all of the recommendations it is unwise to assume that she will follow through.

The alternative, then, in the case of mitral valve disease, is valve repair.  Although this is not meant to be an extensive discussion on mitral valve therapy, I will point out two important issues.  The best methods of valve repair in the setting of inflammatory disease, especially mitral stenosis, are controversial, and in western countries this is not routinely attempted.  Secondly, a failed valve repair here is even more of a problem than in the west.  Many patients will not return for follow-up, most patients cannot afford a second operation, and the risk of repeat chest surgery in this setting is significant given the limitations and costs of blood products, monitoring, and advanced supportive therapies.

An additional consideration here that is somewhat different than my practice in the US is the advanced stage of disease at which most patients present.  There are evidence—based guidelines in Europe and in the US recommending the stage at which the benefit of surgery will outweigh the risk.  Even if the risk of surgery is slightly higher in this setting (and I am not sure that it is), most patients present well past the recommended time of surgery.  Even if they come for consultation early in their disease, they wait a long time for surgery due to fear, lack of support, and financial considerations.  And of course, the options that Americans and Europeans have of heart transplant or artificial hearts are not available at all without travelling abroad.

One final area that looms large, that I have mentioned above, is cost.  In the US, cost is something of a general issue, and we do not often consider it as a deciding factor in the treatment of individual patients.  At the cardiac center, we can overcome the cost issue for the in-patient care of many patients.  However, this does not make the issue go away.  Some patients have co-morbidities or suspicion of co-morbidities, and additional evaluation could be beneficial.  We do not have a CT scanner in Shisong (although hopefully that is coming), so if a patient has a problem best evaluated by CT scan, they must travel several hours and pay for the CT scan, and bring the results back to us.  There is other testing and treatments for which patients must travel and pay additional fees, and we must decide whether to proceed without the tests or not.  In the US, there is always a point at which further testing is not cost-effective, but that moving target is even more difficult here.  From an anesthesia standpoint, deciding to proceed now versus advocating waiting until different drugs or supplies are available is not something that often applies in my practice in Rochester.

In the US, we often over-test, over-treat, still fail to have optimal outcomes, and assume that someone else will pay for all of it.  Here, the answer is frequently, “you can’t have that,” and we are still left to make decisions with the information that we have based on our discussions with the patients and hope to honor their trust and dignity.  I am confident that we always act with good will and that the personal conflicts of interest are minimized.  The rest remains difficult.


From today’s liturgy: “They ate and had their fill, and what they craved the Lord gave them; they were not disappointed in what they craved.” (Cf. Ps 78:29-30)