Tuesday, May 5, 2015

writing: vaccines, Baltimore, challenging patients, friendship

The big projects I alluded to last time are out now, plus some stuff that has popped up with recent Baltimore happenings.

For The Love: Why Christians Of All People Should Get Vaccines- My first cover story! I was really glad that the Christianity Today team didn't just ask for the same old "vaccines-are-safe" piece, but an extended theological reflection on public health and faith. I did my best to deliver (some stuff had to get cut for space reasons, but all the best parts are still in there.)

Let Sandtown Speak For Itself- With all the media craziness happening in my neighborhood, there's a whole lot of unjustified bloviating. Fortunately, there has been some good media coverage that highlights the voices of my neighbors, who deserve to be heard.

The Policing Baltimore Needs- I found a lot of rhetoric around the Freddie Gray situation unhelpful: there's a lot of anger towards the police that doesn't recognize the role that they might play in making neighborhoods like Sandtown safer, but also a lot of reflexive defense of the police that doesn't recognize how much trust has been undermined through overaggressive policing. I tried to thread that needle, relying heavily on what I've learned from following David Kennedy over the years.

Maryland Family Physician: Challenging Patients- I was guest-editor for this edition of the Maryland Academy of Family Physicians' quarterly journal, so all errors are totally on me. My friends and colleagues wrote some great pieces about how to deal with some of the patients that drive us and our staff crazy-- particularly how family physicians are uniquely suited to addressing these challenges. The centerpiece of this issue is my friend Dr. Joey Nichols' piece on adverse childhood events/trauma and the role that individual physicians as well as health systems have in addressing the health problems related to ACEs. There's also a great article about controlled substances from Dr. Andrea Gauld and a "virtual panel" moderated by Dr. Kathryn Boling featuring many of the physicians who taught us about how they approach challenging patients.

Material Dimensions of Spiritual Friendship- Wesley Hill's new book Spiritual Friendship is fantastic. You oughta read it. I took up some of the questions the book raised for me through the lens of our personal experiences in Sandtown, particularly in regards to friendships with those who are different from us. I'm looking forward to the conversation going forward on how we might culturally (and physically!) restructure our lives to make friendship more powerful. Eve Tushnet is already off to a running start on this one.

Evangelical movement targets poverty- I didn't actually write this, but I was interviewed for this Al Jazeera story about my church and our neighborhood. The segment kinda undersells the fact that Antoine and other community members really are leading and mentoring us relocators in many, many ways and doing a ton of great work themselves (see, for example this video and this profile.) Still, it's always encouraging to see relocation, reconciliation, and redistribution getting discussed in different arenas!

Numerous Elected Officials Suffering From Bizarre Triad of Abdominal Jaundice, Gelatinous Vertebrae, & Microorchidism‏- I am never too cool for an off-color joke about politicians.

Tuesday, March 31, 2015

recent writings

Haven't published much elsewhere lately-- between our new baby(!), support raising, and some bigger writing projects (like Trousseau Syndrome) I haven't had time to churn 'em out like last year. However, I have seen a few things get out there:

Hospital Administrators Bring Hope and Quality To Remote African Village- another Gomerblog article-- where I am now officially a contributor! A lot of what Gomerblog publishes, honestly, is a telling look at the ugly feelings that medical professionals have about their difficult patients (though they have churned out many brilliant stories as well-- most of which are either things I wish were true about the medical system or things I wish weren't.) I'm trying to get at this in Trousseau Syndrome, but I am also submitting as many joke stories as I can that skewer the system from the other side. So far, they've rejected most of those-- when I get enough rejections, I may try to release them as a collection-- but until then, they're still gracious enough to let some of them through.

In Praise of Obnoxious Family Members (and Other Hard-to-Love People)- This is my first article for Christ and Pop Culture, an online community I've found myself engaging with more and more over the past couple of months. They have some great writers and podcasts as well as a secret Facebook group (I know it sounds weird, but it's cool) where a lot of the ideas for this piece got worked out. Check 'em out if you haven't already.

Hospital Merges With Fast Food, Tobacco Companies to “Stay Competitive”- I did not realize that there is actually a hospital with a giant cardiology program with a McDonald's inside of it until I published this and a bunch of people pointed it out. Oops. Like I said, things I wish weren't true.

The Importance of Spiritual Health- It's been a pleasure working with the Maryland Academy of Family Physicians as part of the editorial board for their quarterly journal. They're a sharp and committed group of people working to serve family doctors and their patients in Maryland and I think the journal writers and editors work hard to produce stuff that doctor will benefit from reading. I'm actually guest-editing the next issue of their journal, but this article was my contribution from an issue dedicated to physician self-care. I take on the data with a healthy dose of my own opinions about prayer with patients, the health benefits of religious communities, and how physicians might engage spiritually with patients outside the office.

More stuff is in the pipeline, though, so stay tuned!


Thursday, January 8, 2015

a brief disclaimer on missions, fundraising, and causes we love

As our family prepares to serve overseas in a country that is very poor & politically unstable (click here) to sign up for our email updates and find out more!), you will probably hear me make some comparisons between the developed world and the developing world. I’ll also be asking for money and prayer all the time as well as occasionally insinuating that other people from America could join us overseas. Mostly, the point of this will be to help you understand just how bad off things are there so that you will pray for us and pray for the people we're working with. Here's what that doesn't mean:

1. It’s all about money
Trust me, I know: As a citizen of the internet, I see things all the time asking me for money. Many are incredibly good causes. Most of our family’s giving still goes to personal friends in full-time ministry, and I suspect it’s the same for many other people. However, sometimes folks give because of a less personal appeal (I sure have) and we’d like to take advantage of that if we can. We feel called to a particular place and vocation to serve, but we need thousands of dollars a month to live on in order to do it. We wouldn’t ask anyone for money if we didn’t think it would be used prudently to bless thousands of people in South Sudan who need good maternity and pediatric care, but we understand if maternity and pediatric care in South Sudan is not your thing (see #2 below.) The only reason we’ll talk about it a lot is because it’ll pretty much always be needed to keep things running or make things run better.

2. You should feel guilty if this doesn’t move you
Everyone has their own calling and their own God-given passions. If you’re being disobedient to a call God is placing on your heart, that’s a good reason to feel guilty. If you just don’t feel like reading my harrowing updates about dying children or you have other things that are more important to you that are getting your money, that’s not a reason to feel guilty. (I recommend checking first to make sure that God isn’t placing a call on your heart, as such calls are often easily missed in the insanity of modern life.) I’m glad we live in an age where technology gives you the privilege of participating more generously than ever before, and we’ll never make it without lots of people reading, praying, and giving. You don’t have to be one of them if that’s not where God is leading you, and we can still be friends. I will also not be offended if you unsubscribe from my e-mail list or stop following me on Twitter (although if you have feedback for how to make my emails or tweets better reading, feel free to share before you do!)

3. There aren't problems in America to be fixed
I am proud to say that I’ll continue to be working at Healthcare for the Homeless until we leave (sub-disclaimer: nothing I say on this blog or social media represents their official viewpoint, as I hope you might be able to discern), but the sad reality is that they're hiring because the needs of the homeless in Baltimore are only increasing. I have heard people say that they can understand poverty elsewhere and appreciate the importance of fighting it overseas, but there are so many resources available (maybe too many) to the poor here that they have little sympathy for domestic poverty. Such a viewpoint is, quite frankly, uninformed but easily correctable. We aren't going overseas because the work is done in Baltimore, we're going because we believe God wants us to go elsewhere and He has more people here who can do the things we've been doing here than He does there.

Proportion of physicians by country. Source: WHO, 2006

4. Other causes aren't important
I love great music. It has helped me through some tough times in my life and it has been a part of some of my best experiences with friends and at church. I have given plenty of money to artists that I love to listen to because I want to support them in what they do and can keep doing it. There are many artists who feel judged for pursuing a life of creating, especially if their art doesn't have an explicitly Christian focus. I think this is silly; it is good to create things that are beautiful or that tell the truth in ways that stick with us. Heck, even great video games have been part of my self-care for a while; what’s more frivolous than video games? Entertainment is a part of our lives and thus part of our culture-- if we're going to spend money on it, we should spend it on the best things. We should still spend more money on helping to keep people in other countries alive past their 5th birthday, but hopefully you can see the difference between the two sentiments.

Similarly, injustice in America is bad (see point #1) and events like the death of Eric Garner expose the importance of working for justice in America and disavowing complacency. However, it is still important to recognize that Brown's death is horrific because we have a standard of justice that the majority of Americans can expect; in many other places around the world, extrajudicial killings and other severe miscarriages of justice like his are quite commonplace. This discrepancy doesn't make his death less deserving of attention (or our justice system less culpable), but it does make other deaths more deserving. The Locust Effect elucidates this distinction (as well as how our country went from a very unjust system of law enforcement to a more reliable system in less than a century.)

5. There aren't people in other countries solving their own problems
One of the great things about going overseas at this point in history is that we get to learn a lot from those who came before us. One thing we've learned is that when outsiders do all the work, locals are disempowered. So, then, a big part of our job is going to be equipping locals who are already serving and working for the good of their own people so that they can be more effective. Just because we got on a plane (or moved into the 'hood, as the case may be) doesn't make us heroes. There were locals working in poor places before we showed up and they'll be there when we leave. Some have even chosen to stay when they had the option to leave, which is a pretty powerful testimony if you ask me.

6a. You're inadequate because you're not doing what we're doing
I hate this one because I know folks are usually trying to be nice when they say, "I could never do what you do and go help those people over there!" Really. I appreciate the sentiment. But it's bad theology-- because if you're a believer in Jesus, then barring any serious illnesses or unrepentant sins, the Holy Spirit could equip and empower you to live in a hard place and suffer hard things. Really! I promise! And I can make that promise to you because it’s the same one that we’re clinging to in order to survive the hard times in our hard places when we feel inadequate to do what we’re doing. Because we feel that way sometimes, too.

6b. You should feel guilty for your comfortable lifestyle
I've never heard this one stated in this way, but I have heard people try to defensively downplay the role of sacrifice in Christian living. I already wrote about this elsewhere, but I am going to give every individual I meet the benefit of the doubt and assume that God has called that person to the station and vocation they're currently in (unless they have said something recently about "persecution of Christians" with reference to a waterfowl fiefdom and they don't pray through Voice of the Martyrs regularly. Again, an easily correctable deficiency! ) Given the mismatch between the needs of the world (including poor rural and inner-city areas in America) and the blessings held by wealthy Christians, the only conclusion I can draw is that some believers are hidin' it under a bushel, burying their talent in the ground, and packing their bags for Tarshish. But that is between you and Jesus, not between me and you. God's call to each of us is unique, but the faithfulness He commands us to is anything but. Besides, we can't go without a strong home base of support.

7. We're special
Man, I'd really like to think so. It just ain't the case. We're obedient to our call, just like my neighbors C.W. & Amelia who stayed in Sandtown or my doctor friends who are providing great care for their patients in a small town or the moms I know who are raising their kids. We just think that God has called us to be faithful in a different culture, that's all.

With that said, we hope and pray that your participation in what we do-- whether it’s just by reading or by praying and giving-- is a blessing to you.


Thursday, December 18, 2014

around the web: medical missions and more!

I've not been writing as much lately (working on some longer things, including but not limited to Trousseau Syndrome), but here's the latest:

Public Health and the Common Good- Growing up within conservative evangelicalism, there was a view of government that seemed to focus on Romans 13 as the guiding text for understanding what government can and cannot do-- as if punishing evil were the only divinely sanctioned activity of the state. I think we must have a more expansive view-- not only because the genie is kinda out of the bottle already, but because the state has tools (primitive and crude though they may be) to help shape the health of the people. However, it is even more important that churches take an active role in promoting the health of the communities it works and that the church at large speak prophetically to the state to challenge politicians when they overreach or are neglecting certain populations. Cardus is such a fascinating organization that is doing some great research and advancing meaningful conversations, and it was an honor to write for their magazine.

"Helping Without Hurting": The Global Missions Health Conference- In case you haven't heard, we're moving to South Sudan next year to work at His House of Hope Hospital there (a longer post about this is coming, but in the meantime, why not sign up for our mailing list to get updates?) The Global Missions Health Conference has been a really important part of our journey to the field, and I was glad to be able to tell part of that story in this piece.



Engagement is Discipleship- I don't think evangelical Christians appreciate the degree to which ministering to others is part of our spiritual growth, and I think that this should shape our discussion about "withdrawing" from "the culture."

The Medical Professional Development Drinking Game- In terms of likes/shares, this is the most popular thing on the internet that I've ever written. That tells you a lot about the internet. If you'd like to change that, feel free to share any of the other things I've written that you think are more deserving.

Tuesday, December 9, 2014

poem: "labor pains"

as the contractions spaced closer together and the fluid ran down your legs
almost as fast as the movements of the innkeeper's head side-to-side
your husband was there, at least, but he'd never tried to make a baby
much less help one come out
no mother, no aunt, just a heifer who'd done this just a few times herself
there to give you a derisive snort
at some point, did you ever think "this is looking bad"?

when you tried to push and all that came out was more shit
thinking to yourself, "oh, great, that's all this stable needs"
that's all this world needs
what did the dirty straw feel like on your bare skin?

with the head descending, when you felt something ready
like you could burst apart or die and either would be better than right now
afraid that both might happen but take their time in coming
trying not to scream and disturb those who paid to sleep comfortably
after all, they told you once already to knock it off
did you feel the rage prick at you like the straw?

what you have been asked to do, it seems, requires your body
no part of your flesh can turn back from the submission your soul led you into
so as He passed from you to us
was the tear through your labia deep as the one through your heart?

when he came out all purple and still
not breathing, not crying
soaked in blood and amnion with the cord wrapped once, twice, three times around his neck
thinking maybe it was all your imagination
angels and promises and unfulfilled magnification
were you afraid in those long seconds?

so then when He suckled, surely you could not have known
that there were others doing the same
others who would weep and beg as the king's men tore their babies off their breasts
and when you found out, did you know they'd find Him eventually, too?

as He slept in the trough with the animal cud
surely you must have worried that He was wrapped warmly enough
that He'd suffocate or that you'd sleep through his cries for food
that you would not stop bleeding in the middle of the night
and when you awoke to his scream, did he bite
or did He find a way to take gently all that you'd been given?

and tell me
tell me
tell me
if you know
what came of these labor pains
what is coming
what is to come?



Sunday, October 5, 2014

three buttresses in defense of the liberal arts

Alan Jacobs wrote a great post about defending the liberal arts and my comment quickly became longer than his post. So I'm going to put it here on my blog, because as an aspiring medical educator I really care about what sorts of things are forming the people who might eventually become medical professionals, and the liberal arts are pretty darn important in that formation.

You should read his post, but what you have to know to understand this one: Alan talked about three audiences that one has to defend the liberal arts to: people in the liberal arts who really can't articulate why it's worthwhile, people who idolize science and rational inquiry to the exclusion of any other discipline, and people glued to the concept of financial renumeration for one's work (and here he mostly offers up anxious parents of potential Philosophy majors.) I think that he's indeed encountered a tough nut to crack with the third audience. Here's my perspective:

When I was 14 and finishing my first year of community college, my father sat me down and said, "I know you'd like to be an English major. Let's see what kinds of jobs there are for English majors." He pointed out the low income potential I was looking at and encouraged me to think about a career in science. (He later told me that he regrets this pressure.) I decided to be a Chemistry major (which I enjoyed until about junior year, at which I realized I was not at all a researcher) and switched to pre-med. I am now a family doctor and love what I do during the day (at sometime in the middle of the night-- babies come out when they feel like it!) with all of my heart. I am really thankful that my father did what he did, because it nudged me in the direction that worked out very well for me.

However, I still write essays, blogs, short stories, poems, songs, and longer fiction (go read my novel if you're interested! It's sort of about this very kind of thing.) I am much happier (and more financially secure) than I think I would be if I had pursued my original dream as an English major. I was incredibly blessed to have scholarships that allowed me to study abroad and take music lessons during my undergraduate career, which were no doubt incredibly influential in forming my opinion on this subject. While my experience probably represents the minority of would-be liberal arts majors (that is, I was well-suited for a medical career and didn't consider until I had already done 3.5 years of undergraduate study), I think it is representative in that many people (especially liberal arts majors) don't work in the field of their college major.

Thus, I think we have to do three things, and we have to do them with both idealistic students and their anxious parents listening carefully:

First, we have to recast one's college major as less important than the skills one learns in college. We have to remind the idealistic students that while they will acquire some specific knowledge about various subjects whilst in their major and that their choice of major will certainly be a factor in guiding them to a career, what a bachelor's degree means to a great number of people is simply that you can write a sentence, follow directions, and show up on time. Conversely, we have to pry this conviction about majors from the hands of anxious parents. I will never forget a biology professor at Hopkins very patiently explaining to a roomful of potential undergraduate students and their parents during a campus tour that there is no such thing as a pre-med major and you don't even necessarily have to have a biology major in order to become a doctor. They really didn't get it.

Second, we should make the point strenuously that Alan makes regarding the second audience: every good engineer should know how to communicate, every good doctor should understand the social dynamics of power and class privilege, every good researcher should know the Greek myths and the Resurrection story. If you can sell the third audience on the fact that being steeped in the liberal arts at some point in your life makes you a better engineer/doctor/lawyer/researcher (as the Mayor of my esteemed city recently put it, "Of course I like art. I went to goddamn Oberlin.")

Third, we have to reorient liberal arts such that Alan's lofty description (which I heartily endorse) of the liberal arts as a "way of life" is more open to people who are not liberal arts majors or working full-time in the liberal arts. I don't think this idea is particularly novel, and I have no doubt it's the sort of thing Alan does (that's the impression I get from talking to any of my Wheaton friends, anyway.) There's probably more heavy lifting that needs to be done among his audience #1. I think a lot of young college kids would be far more likely to become accountants or chemists if they knew that they could still take plenty of literature classes while in school and then continue to read (and even write!) literature after they get home from their 9-to-5 job.

In Matthew's fantasyland, taking point #3 seriously would lead to a greater appreciation of the liberal arts among those who have balkanized themselves away from such a "way of life" (or been put off by the academy's hoity-toityness.) If you'll permit my pipedream to run away even further, this embrace of such high-minded mumbledy-peg will eventually reach the point that we'll spend less money on garbage entertainment and more on quality journalism, art, music, and literature (or creating our own!) that will in turn allow for these professions to support more people who are gifted and dedicated enough to do them full-time. Then we'd have an even stronger argument to take to these money-obsessed folks. This is what I try to do in my own life, and I hope you, do, too.

Friday, September 26, 2014

around the web: healthcare and Baltimore

This summer's been a good time for writing, and I've gotten published in a few new places! I have also been selected as a Copello Health Advocacy Fellow with the National Physicians Alliance, so I'll be focusing a bit more on stewardship & transparency in my medicine-related writing these days. I figured I'd once again collect my writings here in case you missed anything.

This Demon Only Comes Out By Prayer and Prozac- I think addressing mental illness frankly is really important. Not only is it rather common, but it is often disabling and sometimes deadly. However, the way we talk about it-- especially using words like "chemical imbalance" or "personal choice"-- is sloppy and can be harmful if we don't recognize the interplay between mind and body that can help or hurt those who suffer mental illness. I tried to make the case for a more meaningful holism.

Beyond the Pink Police State: Community Health Workers- James Poulos' Pink Police State series at The Federalist this summer left a lot of people scratching their heads. I found it fascinating, even though I disagreed with him pretty sharply on a number of things. His central thesis is pretty spot-on, though: we're surrendering our freedoms for government-sponsored hygiene. I think that food, not sex, is the most important aspect of this, and I also think we'll need to use the apparatus of the state against itself and pay community health workers to develop a meaningful counterbalance to its regulatory overreach. I worked really hard on this one and it didn't get a lot of attention when it came out, so now's your chance to read it if you didn't before (or ignore it again, if that's what you please. It's no skin off my nose if you do.)

How Casinos Corrupt Cities- This one was a lot of fun to write-- if only because crony capitalism among Democratic politicians in Baltimore and Maryland reaches comic proportions quite frequently. My personal favorite is when our Mayor and Governor proclaim that they are "data-driven" and yet promote casinos, which are pretty well proven to damage local economies. I also mentioned a few meaningful alternatives to the sort of flashy downtown development that we all love to hate. I'm hoping to write more for The American Conservative in the future, which you should check out if you haven't already because they publish a lot of really thoughtful and worthwhile things.

Primary Care Providers Can Handle Hepatitis C Treatment- My first real op-ed! Now get off my lawn, specialists. No, seriously-- I love specialists, and they take good care of our patients when we all work together. But they shouldn't have to see every case of Hepatitis C in Maryland, because primary care doctors can prescribe these expensive new drugs intelligently. Maryland Medicaid disagrees, though. The best solution, obviously, would be for Pharma to stop charging so damn much for a medicine that's already going to earn them millions of dollars.

Mere Fidelity: The Benedict Option- I really enjoyed this conversation about withdrawal and engagement in an environment of cultural hostility to faithful Christianity. I will hopefully be doing more podcasts in the future and my article on the Benedict option is coming soon!

Medical Missionaries and the Role of Evidence- Slate published a rather poorly-written article exploring some of the deficiencies in medical missions and expressing unease about proselytization... but the author, Brian Palmer, really didn't do his research very well. I took the opportunity to point out where good research and quality improvement are happening and have been happening within medical missions, exploring the historical contributions that missionaries have made and the strengths of a Christian approach to health care in the developing world: