Because

As I think through the potential “why” answers in my previous post,  I have been trying to journal my personal answer. Here are my top 5 reasons based on my 6 months away so far.

1) Calling / obedience - 14 years  ago I came to Togo as a medical student. A series of events that followed convinced me that one of my God-given purposes in life is to continue to help out here. While we couldn’t have known what that would look like from year to year - we have tried to make progress toward joining in what God is doing here.  Elements along the way - career change, supportive co-workers / family / friends and all the ways God encourages us through his mercy on us and the people here - keep us linked to this work.

2) I love and admire West African people. I think they must be some of the toughest people on Earth. They are very stoic in the face of suffering yet warm and gregarious in daily life. 

3) We have friends here. You get to work with amazing teammates in places like this. Many have a unique view of the world, understanding what seems like an alternate universe in terms of cultural dos and don’ts, developing world financial realities and life in the absence of basic infrastructure. Some have an unstoppable faith and commitment. Some are in the second half of life and bring a wealth of knowledge and experience to the problems at hand here. It is a close knit community in many ways - something I haven’t always experienced in life elsewhere.

4) I want to hold the big disparities in our world in my mind. Something along the lines of “to whom much is given, much is required.” A few examples of what I mean…  When we asked our guard for help killing a rat in the chicken coop - he did it fearlessly (I wasn’t about to get near the giant thing) and then cleaned it and cooked it over a makeshift campfire that same night. We spend more in a week in groceries alone than some laborers here make in months. I drive past half-clothed kids at the local dump and ladies carrying water on their heads to their homes and then shop for fully finished homes online for our return to Stateside life. Yesterday, a patient came in with this non-union femur X-ray from a nearby sizable city - the impression at the bottom means “good healing”. 

5) I want to love without fear and raise kids who do too.

Recently I had a terrifying nightmare of a terrorist attack here. I woke up with so much adrenaline release that it took awhile for my pounding heart to slow down. 

The following morning I read a BBC News story about an attack in the country to the north of us, this time on the French embassy there.

http://www.bbc.com/news/world-africa-43257453 

Later that day I was taking time on rounds to explain post-op care to a patient. I had repaired his bilateral groin hernias the day prior, the fourth such attempt for him. He had first undergone surgery at an “Arab Hospital” (later he clarified a Qatari one) in Cote d’Ivoire followed by two hernia repairs in Burkina. 

He was very happy that he had essentially no post-op pain in comparison to the pain that he described of prior operations. This was probably because I had severed a few nerves in cutting through all the scar tissue from his prior operations.  He seemed to really understand my explanation of how the hernia mesh I had placed works (my typical “reinforcing wire in concrete” analogy). I suggested he follow up in a month, at which time he pointed out that he lived north of Ouagadougou and it would be difficult to return. 

I had this fleeting thought - “What if he is one of the ‘bad guys’?”…. I asked, “If he is from so far away, why did he come here?” He said he had heard that “the work here is good,” as my translator put it. Now we were tracking together through smiles, both happy that our paths had crossed. I made him a deal - if he had no post-op problems - he didn’t need to return for follow up. I explained the 10 kg lifting restrictions. He asked about his relationships with his wives. I felt that we had a mutual understanding of his recovery plan. If I didn’t hear from him again, I’d assume he was doing well. 

Then, I asked if I could pray for him before he left. “No problem” was the reply throughout the translator…. I felt the nudge to go further. I explained that I had read just that morning about the problems in Ouagadougou and I told him I would pray for him and the Burkina people. My translator, who also happened to have trained some as a nurse in Burkina, and the patient seemed to appreciated where I was coming from. I asked God some of my typical requests for patients who I am about to discharge… thanking him for them, asking for their healing, asking that they would know Jesus better though their time here. But for this guy - I added prayer for his people, for peace and safety. 

It was a special time filled with the joy of love edging out fear.

Why

“It is worth asking why a health care professional who is capable, respected and experienced would leave his or her home, job and loved ones to go to a challenging, exhausting and possibly dangerous destination.”

This sentence leads off a very insightful section in the Global Humanitarian Medicine and Disaster Relief chapter in Wilderness Medicine, a fascinating textbook in the medical library here. 

According to the authors, providing medical relief is the primary motivation for most involved in this work. This relief first involves action such as a surgical procedure or consult, then being with patients physically and emotionally in their suffering and then bearing witness so that those suffering do not do so alone.

It has been helpful to read a concise list of potential answers to this “why” question, to reflect on my own motives and to understand where others involved in this type work might be coming from. Each reason listed in the chapter has merits and drawbacks and it is noted that many ideals are “mulled over” in the course of these deployments. Here are my take-home notes from the textbook on this subject.

1. Help people in need / relieve suffering - This is a laudable goal that the world could aspire toward more. One drawback is when the “helper’s high” or “doing something good” can be self-serving and used as a means to a personal end. This desire might not suffice if the culture served in has no grid for “volunteering” and assumes an ulterior motive for the service. While volunteerism is commendable it can lead to financial and domestic difficulties if not done with balance.
2. Testing oneself - In the absence of diagnostic technology or readily available specialists, an austere environment might hone physical exam skills, resurrect knowledge from medical school days or push some into learning new procedures. In contrast - skills needed in your home role might be neglected and require re-learning.
3. Medical tourism / adventurism - Our credentials can be a ticket to world travel. Having a “cross-cultural experience” has many benefits but this attitude might segue to “voyeurism and reductionism that can trivialize patients and their situation.”
4. “Check-mark syndrome” - Working in an emergency situation is just “one more box to tick off the list of having done it all.”
5. Fleeing a negative situation / finding oneself - Some may be looking to get away from personal relationship failure, professional frustration, or disillusionment with values of their home society. They might find a cause to channel their energy toward. 
6. Personal conviction, philosophy or religious belief - These ideals can serve as a sufficient motivation to serve and advocate. People of this mindset might feel that the suffering they see needs be shared with a wider audience and speak up on behalf of their patients. Local governments might not share the worker’s sense of social justice or beliefs which can limit their advocacy in the interest of patient or team safety.  Challenges arise when “there is discordance between foreign ideals and local culture, politics and traditional power structures.”

The section in the textbook concludes with an observation that we are all complicated humans who sometimes experience boredom and ambivalence in the midst of joy and fulfillment. However, we better understand the human condition when we enter into and see the “beauty and brutality” of the lives of others. This challenges our ideas about how the world works. Also, we see what we have in common can transcend great distance and our differences in language and culture.