No doors, no drawers

The following is an essay that I wrote for submission to the University of Minnesota's Global Health Newsletter after returning from Peru.  Many people have helped me refine this piece (thank you!). And encouraged me to post it on my blog, regardless if it is accepted by the GH Newsletter.   It has taken several months to hone and process and arrive at it's "final" form.  "Final" is also quite relative, as these thoughts are ventured here out of humility, a desire to grow, and honest searching.  Please take it with that in mind, and with an invitation for more dialogue to come in days ahead.

No doors, no drawers

An essay by Kate Venable MD, CTropMed

It was some time after I left Peru in March when I realized that the indigenous people group with whom I had the privilege to work had existed successfully for hundreds of years with no doors and no drawers… no keys or locks, no towels or sinks.  They live with their environment, for better or worse, not excluded from it. They are completely dependent on the Chambira River in the Amazon Basin for water and fish, for bathing and washing, for the plants and animals of the jungle, for practically every aspect of life.  And have been for hundreds of years.

To put this in context, I was part of a community development team that has been meeting yearly in March with this people group in the Amazon Basin of Peru.  Though it was my first year as part of the team, these “Annual Meetings” – focused on health, literacy (the initial connection which spurred the Annual Meetings), agriculture and spirituality—were initiated several years ago by the community itself, with support of Peruvian and foreign volunteers.  The indigenous community had been working with a literacy project, and through that connection and growth, became hungry for input in other areas of life.

Prior to the Annual Meetings this jungle community had encountered the “outside world” through various avenues:  the literacy outreach project, oil-seeking businessmen, anthropologists eager to study their cultural practices, jungle eco-tourists, service-oriented medical teams offering miniature floating clinics, and the Peruvian government—trying to figure out how to bring the indigenous under its authority while still allowing them a degree of autonomy (clearly a polemic topic, unfortunately not to be addressed here).

Some in this community have sought medical attention from physicians in the cities, though they are the exception, and some of them have been exposed to basic health education. Community Health Workers (CHWs) from each community had been appointed by the Peruvian government, but typically received little training along the way.  In hopes to augment their training, the indigenous community leaders requested that the Annual Meetings include some training for the CHWs on potable water, basic health concepts, and common conditions encountered in their villages. This had been done in the few years prior, using a community assessment tool called the “Ten Seed Technique.”[i] All involved recounted tales of how gratifying and helpful it was to learn the indigenous CHW’s perspective on their health needs, causation of disease, and the health priorities held by the community leaders.

When the CHWs came together at this year’s Annual Meeting, discussion continued on some familiar topics.  While discussing issues associated with non-potable water consumption, the question arose about how many among them regularly implement methods for purifying their own family’s water. One of the 20 CHWs volunteered that he uses a small amount of bleach in his water. No one else spoke. Many eyes were averted.  The volunteers listening sat in silence as well. This was profound.  It did not take long to calculate that this one man represented 5% of the CHW’s in this community (of the ones attending the Annual Meeting, but likely a reasonable sample)… and that only a very few were implementing what they had been taught regarding water safety and disease.

The silence was soon broken, and the CHWs were asked why they were not treating or boiling their water when they had been taught that it makes them sick. Their candid responses were as follows:

“We have been drinking from the River for hundreds of years – why should we cook the water now?”

“What do you [read: gringos] know about our river? We live in communion with the river for every part of our life. You do not know the river like we do.”

“My children don’t like how the water tastes when we boil it – it tastes like smoky fish.”

This one CHW who treats his family’s water supply voiced, “My children used to dislike the taste [of the bleach-treated water], but now they drink it and we are not often sick.” 

This is the change – 5% of the community - that has come after over several years of teaching, being given the opportunity to see with a microscope that more exists in water than what we see with our eyes, after receiving education about cause of illness, hygiene and the basic concepts we may even accept as common sense. 

The scene closed shortly thereafter, as the sounds of lunch time offered a natural escape.  The CHWs dispersed, the volunteers packed up their teaching materials, and we made our way to the dining area for lunch. And no more conversation over potable water would be had for the remainder of our time with these CHWs.  Enough had been said.

The humility and courage of this lone CHW continues to captivate me. The objections and honesty of the others likewise speak a clear message. Even today, I am still trying to listen.

I return again to the phrases with which I started: No doors … no drawers. It was certainly not my first encounter with indigenous people and their way of living. I have had the privilege of meeting various people groups on several continents, including this same region in the Amazon Basin, who also live without the confines of keys, locks or doors, doing what their people have done for centuries, in these same lands and rivers. 

And so why did these scenes strike me with such weight, lingering for days?   I think because I was expecting that they were living out the hygiene lessons I had been told “were already taught” to this people group.  And perhaps their realities faced off with my comfortable, “established” (Western), North American approach to health care, staring with an unwavering gaze, demanding that I more deeply examine the weighty matters of culture, power, education, medical care, and expectations surrounding the results of my (our) “service” in their community.

My reflections have stirred many questions regarding my own personal approach to the health needs of people living like my jungle friends.  Here are a few:

• Is it really appropriate to give albendazole, explaining that it kills the “bichos”  (regional term for parasites/worms) when they are drinking the river water to wash it down?
• What if they feel better after the one dose of albendazole (for a few weeks anyway) and think, “that pill from the foreign doctor made me feel better…I need to get another pill”?  And find their way to a pharmacy or health post to consume albendazole too frequently, thinking that more is better?
• What will they do with the little plastic bag of amoxicillin I give them to treat (maybe) pneumonia? Since there are no drawers, no doors - where will it stay? How will it not become wet like everything else during the two day canoe journey back home when the inevitable, daily rains come?
• Are amoxicillin and other pharmaceuticals really the best type of treatments for these people?
• What happens when a patient’s cultural values promote sharing equally between all persons in the family, and therefore the patient gives each person a dose of amoxicillin that was intended for one person’s pneumonia?
• Do I honor and serve them, respecting their dignity as human beings by applying my allopathic treatments to them in spite of their unbelief about microbe-based/water-borne disease causation?
• Do I perpetuate dependence on foreign aid and perceived powerlessness by bringing “free” treatments and offering “free” medical care? (Reality is, of course, that both have a cost. What’s more, patients are not, in most cases, utterly destitute and could bring something to the table?[ii]) Would it be better to suggest that each family bring something to contribute to their medical care and medications–for example:  a bushel of plantains, a woven mat, some fish?
• What is the effect on the local economy when I bring supplies from the US to give away free to patients, who, without my free offerings might find a way to purchase something from their local clinic or pharmacy?  (Again, realizing that some of these people do NOT have access to such resources or that it would cause an insupportable financial burden for some.)
• Are there ways that I (or someone else) could better meet their needs, taking into account environmental concerns, resource-appropriate treatments, geography and culture?
• Might there be many effective plant-based remedies growing at their fingertips that have been abandoned in hopes of the occasional “magic pill” to fix that which ails? (I know for a fact that there is a large institute in Iquitos, Peru which studies the botany and natural resources of the Amazon Basin, aiming to respectfully and appropriately take advantage of the Amazon’s treasures – for health and nutrition, and many other purposes to be sure.)
• Does this specific people group simply need more time for that one CHW to model his water treatment to his village, demonstrating how his children aren’t sick with “bichos” any longer, so that the villagers believe him, while they reject or ignore foreigners’ teachings?

These are uncomfortable questions.  They touch on the core of our “diagnose-treat-cure-repeat” model. They threaten my paradigm that I am a well-trained American doctor, and so therefore I “know” how to be a doctor, anywhere, for anyone.  They also raise difficult questions about our motives, and perhaps the implications of our efforts to help.  I don’t have answers to these difficult questions. But I believe they need to be asked – if nowhere else, in my own life – as I consider what kind of involvement I want to have in the Global Health arena.

I believe there is a role for allopathic medicine in some cases and settings: for vaccines, basic teaching and modeling of hygiene, water management, and nutritional concepts.  I don’t know who is the best person to share allopathic medicine with cultures world’s away from our own. I suspect that local, national efforts are best, and better still ones that are indigenous-led.  I have seen some of these efforts at work throughout the world…but they are not quick, nor especially plan-able. They cost a lot of time, investment from a community, and a patient, open-handedness (on the foreigner’s part) to wait until the community is ready to affect its own changes.  I think that knowing to some degree the Amazon Basin’s people after my three other visits and time spent there, talking (in Spanish) with local people, and learning about their beliefs and values, helped create my awareness of the situation above, and it’s profundity.  This also takes time. A lot of time.  And in our hurried, outcomes-based, results-driven world (and profession), we are often unwilling to offer to our patients the proverbial ‘tincture of time’ as it might pertain to health and development.  

There are certainly a number of these conversations going on in the world, undoubtedly more than I know.  Recently, I encountered an article referred to me by a friend (who is on the board of directors for Doctors for Global Health, an excellent organization doing solid work empowering local communities in health and development): “Rules of Engagement: The Principles of Underserved Global Health Volunteerism” by Dr. John Wilson and colleagues at Mayo Medical Center in Rochester, MN.[iii] I commend this article for reading on their experiences and challenges, in particular as they examine such principles with medical education in view.

Having opened this can of worms (or bichos, if you prefer) I can only hope it will stimulate reflections, conversations and dialogue, leading each of us to examine how we might live and practice with ever-growing cultural sensitivity to our neighbors—even those right here at home.   I know after the scenes I described above, my group of volunteers (Peruvian and foreign) began some difficult discussions on these sensitive matters. I don’t at all question the intent of my Peru-based team, or others of which I have been a part.  The challenges in these situations are many, only one of which is that in my example, the medical team was invited by the indigenous community, and there were relationships established and groundwork laid in years past.  As we witnessed during our week as a whole, expectations, assessments of needs, balance of costs, division of labor, and projected course all vary widely depending on our culture and experiences.  And it seems the most lasting, sustainable projects are forged through committed relationships in a community, with shared resources & local investment…  and a lot of patience with the process.  This is happening with my jungle friends – but very slowly.   One CHW at a time. My hope is that by examining these matters, we might serve well, share our resources appropriately, and be respectful of the doors we find before us.  

 

[i] The Ten Seed Technique is a modified Participatory Learning and Action (PLA) tool. It was introduced by Dr Ravi Jayakaran as a tool that can enable illiterate community members to participate in the discussions about their community’s needs.  See http://www.csd-i.org/ten-seed-technique-field-note/

[ii] An excellent book called Toxic Charity by Robert Lupton has recently shaped my thinking on the issue of free care in settings other than emergency/crisis.  It’s more focused on social services than medical, but there are definitely applicable principles.

[iii] The American Journal of Medicine, Vol 125, No 6, June 2012

Perspective

I imagine the conversation may have gone something like this:
"Could we go?"
       "Could we go? ...  what do you mean? Women don't go to these meetings.  There were only a few  of them there last year, and those are the ones from that other village - that village where there are many Jesus-followers.... We're not like them."
"But what if there are doctors there this year? I heard that there were doctors last year..."
       "But what do the foreign doctors know?  They do not live here in the jungle ... they are not U*!"
"There might be a chance they could help my eyes ..." 
       "You've been blind for 'tiempo' - what can they do about your eyes now? They don't have that kind of power..."
"I heard they helped a man last year, from that village where they follow Jesus... and his eyes were becoming sick. But now he can see at least with one eye.  And my mother said there are many women going this year.... and children, youth."
       "There are many women going?  And children too? ... How does your mother know? Is she going?"
"She wants us to all go - our whole family. And maybe there will be some help for my eyes.... I am too young to lose my sight.  There may be something the doctors can do... if there are doctors there."
        "Maybe ... Maybe... "


Whatever the conversation leading up to the decision to leave their jungle village, 2 or 3 days journey in a canoe, through jungle waters of the Rio Chambira ... they went. They came. To Aurora, to the yearly meeting of the U* with our team of mostly foreigners. I don't know if they really came for the possibility of seeing a doctor, if they were planning to come anyway, or if my speculation is even close.  I believe it was the first trip to Aurora for their family. But Rosa, blind for "some time", did get to see a foreign doctor, was prayed for several times, and the power of Jesus to heal hopeless conditions was shared with her - all maybe for the first time.


It is true that there were few women at Aurora last year; none in years past.
It is true that Rosa's mother was there - caring for her middle aged daughter who cannot see.
It is true that these women had the courage to come to someplace new, to reach into unknown places, to meet unknown people. 
It is true that there was a man last year with an illness affecting his eyes, and that after being seen by the doctors last year, was referred to an Ophthalmologist in Iquitos and his vision was partly spared.
It is true that women were not thought able to read until very recently.

Perspectives change. Even deep, deep in the jungle.
 

The U* women - some 60 women came from ~10 different villages

So it turns out that our prayers for Rosa have been answered in part.  Kathy updated me briefly that she was evaluated and has a cataract in one eye (as we suspected), which can be surgically removed. Providing there is no deeper disease affecting other parts of her eye, providing she can have the surgery, she will have some of her sight restored.   And Jesus can still heal her fully, without any of those interventions. 
May her perspective be changed - physically, visually, and spiritually.  And may her and her family's willingness to come, to hope, to ask ... lead them to all see clearly, with eyes of faith.

For now we see in a mirror dimly, but then face to face. [I Cor 13:12]

Literacy in the Jungle: a family affair

Who would guess that long ago, in a land far, far away, a remote jungle people (the U*) would be reached with the Word of God, and begin to desire a way to read it for themselves? Who would guess that my great-uncle had a divinely-inspired answer to that need (and to many like it around the world) which is still bearing fruit today?  And further, what are the chances that I would join a team in March 2013 and meet a family who has been working with this same remote jungle tribe (the U*) for almost 70 years, using the tools that my great-uncle created?

The story goes something like this:
My great uncle is Rev. Robert Rice, and he and his wife Alice started the organization called LEI (Literacy Evangelism International) in 1967, and led it for many years. After Uncle Bob's death, his son Sid Rice took over the leadership of this organization and continues to this day. see this link for the complete story: LEI history.  The mission is to teach literacy through basic "primers" which demonstrate common objects/nouns, verbs and also provide simplified Bible lessons, all as a means of learning to read and write in the person's native language.  These primers have been translated into over 220 languages now, with missionaries in >40 countries.

Kathy working with the U* women on some advanced lessons

Enter Jerry and Kathy Manus, and their wonderful kids Ethan and Emma. The Manus family's involvement in Amazonas-Peru dates back several decades, when Ron & Phyllis Manus (Jerry's parents) began work with Wycliffe Bible Translators to translate the U* language into written form, and had translated the New Testament.  I think (if I have the story right) he and his wife spent ~50 years with this people, and then they handed the baton to Jerry and Kathy to continue this work. Jerry and Kathy joined LEI 19 years ago and were in Iquitos, Peru when my Uncle Bob Rice went there to help write the first primer for the U* language.  Their work continues to this day, and has joined with the work of Renew Ministries, with whom I went for the U*'s yearly meeting at Aurora 2 weeks ago. It was wonderful to see in action this work I have heard about for years in our family! 
The story continues for the U*, who have now witnessed that women actually can read.  Two years ago the leaders of their community believed this was not possible, but were willing to see if they were wrong.  Turns out they were, and women are reading... now even reading from the U* Bible, and helping to lead their people in some worship songs.  This was an amazing story, where seeds planted long before I was even born, are now growing into a beautiful tree of gospel-fruit, transformation of lives, and fulfillment of my Uncle Bob's and Ron Manus' dreams and prayers. I am honored to have witnessed this legacy of my family and the Manus family, and I marvel at the LORD's wisdom and might as He determines the times set for us and the exact places we should live. 

me, Kathy and Ron at their home in Iquitos

Jerry teaching several women at the Aurora Camp

Two U* women leading their people in song!!

Lessons from El Paralítico and El Ciego

Looking from the foot bridge toward the Rio Marañon, which recently flooded

 

(translation = The Paralytic and the Blind)
In any of the experiences I've had overseas, there are always people suffering from conditions which began way before I met them, and will (unless the LORD brings about healing) for years to come.  My least favorite conditions in this category are ones involving the eyes.
First of all, eyes are amazingly complex, intricate, and powerful. They are the lamp of the body, a window to the soul, our means of taking in our world, the tools with which you can see to read this text, powerful communicators, and often tell a story we may not even know ourselves.  Secondly, eye problems were never my forte in medical training, and thankfully (or not...) I refer people to eye specialists when there's an eye problem.  Thirdly, I recognize the finality of conditions like blindness and have nothing in my "medical bag" to treat it.
The first day we arrived to Fundo Aurora (the Aurora Camp), we were approached about Rosa, a woman suffering from blindness for several years. We were asked to go see her, no doubt in hopes that we would be able to affect her condition.  We found her in one of the Cabinas, in the back room where people slept, laying on the plank floor on her sleeping mat. She was likely in her 40s and with her mother, who appeared to be easily 60 or older, now again caring for the needs of her daughter.  Rosa's husband had led us to see her.  We used a translator from Spanish to U*, trying to obtain some details about her condition, though knowing well that there was little we could do.  One of the lovely parts of understanding Spanish, is hearing directly from the person what they have said and often knowing what they mean.  I asked how long she had been suffering from this problem with her eyes.  "Tiempo" was the answer (translated to me from U*). "Time".... she's been dealing with this for ... time.   Still curious, I pressed for more of a sense - was this 6 months time or 6 years time?  After a few words of exchange, they picked the latter.  That is Time.
Upon examining her, she had an opacified (opaque, white, cloudy) lens in the Right eye, but a different appearing cloudiness to her cornea (covering the surface of the eyes) on her Left eye.  Kathy and I had little to offer except prayer and the recommendation for her to go to Iquitos for a visit with an Ophthalmologist. This is not a simple endeavor, but likely her only chance short of a miracle to have even some restoration of her sight.  We collectively prayed for her that Monday afternoon - in English, Spanish and U* - and went on our way, meeting people and making introductions.
Thursday afternoon, I was approached again by Rosa's husband. He wanted me to see Rosa again, and was concerned about her eyes, and headaches as well this time.  Admittedly, I was initially bothered, since I had already made my diagnosis & treatment plan: blindness, unclear etiology, not something I can treat, refer to Optho.  I felt I had nothing further to offer.  However, for her headaches, we had some tylenol, knowing full well that it is but a temporary measure; so with that in mind I returned to her quiet, dark dwelling.  This time accompanying me were Jacinto, a U* leader and believer, helping with translation, and Rafael a young man from the DR team who had expressed interest in being part of our medical work, and joined me to pray for people that day. I was so glad he did.
Rosa's husband brought her out from the back sleeping quarters into the front living space of their community's Cabina, and we sat together on the simple wooden bench, rain starting to fall on the tin roof overhead. We talked about her headache, I offered some tylenol, and again explained that I had nothing to treat her eye condition.  My bothered attitude softened and tears came as I felt the hopelessness of being blind in the jungle. They nodded as Jacinto translated, but then we offered again to pray for her, for them as a family.  They agreed.  Rafael and I prayed in Spanish, as did Jacinto, and we heard him praying for them to have faith, like the Paralytic, and his friends, reminding us as well as the LORD that Jesus healed such hopeless conditions... like paralysis, like blindness. 
As we finished praying, Jacinto began encouraging this family in the U* language to have faith, to ask Jesus for healing, and to remember the Paralytic and the Blind Men who Jesus healed in response to their faith, and His mercy.  (We knew he was telling them these stories because there are words that don't translate in to U* and so we heard "paralitico" and "ciegos" break through the otherwise unintelligible words to our ears.)

Rafael and I sat, humbled, watching this U* brother exhort his neighbors to believe... Even in the face of such a 'hopeless' situation.  We learned later that Jacinto had, just that morning, heard the story of the Paralytic and his friends who brought their hopeless situation before Jesus, in faith. 
Some of these lessons become much more plain in the Jungle, when faced with someone who has been blind for Time.  

Life on the Amazon

a community along the Rio Marañon

We spent our days with the U* on the Rio Marañon, which is one of 3 main tributaries to the Amazon River. The other two are the Rio Ucayali (which is where I went with Amazon Hope in 2006) and the Rio Itaya, which meet at Iquitos and become the Amazon.
It is an amazing part of the world, and a number of people groups have lived there for ages, still today retaining their cultures and lifestyles much like in centuries past.

In this part of the world, transportation is largely by canoe, houses have to endure significant rain and change in water level each year, and life revolves around the River.  These rivers are teeming with life - fish, reptile, plants and animals of all kind. These photos give a sense of what I saw every day, and are strikingly similar to the views I saw in 2006 on the Rio Ucayali, so it was quite familiar in many ways.

The vast expanse of the Rio Marañon

The Aurora Property which sits on the Rio Marañon and extends back to include many other buildings, 200+ acres total.

Our boat (called a lancha) which took us back and forth from the lodge, and served as a classroom for Health Promoters. Some of our team also slept on the boat in tents or hammocks.

The sunsets are spectacular and different every day. This was evening settling over the Rio Marañon from the banks of Aurora.

Wilma

This woman deserves far more than her own post. She is one of the quiet heros of the faith here on earth... a warrior for justice and peace, spreading the love of Christ in some of the most difficult places on the planet. I am different from the brief time I spent in her presence.

me, Wilma, Clay, Josiah in her school

Wilma grew up in Lima, with her 10 million neighbors, and at some point was orphaned or abandoned, and ended up living on the streets as a teenager. She was truly one of the least, likely not sure if she would even survive to see age 20.  At 17, a family (I think missionaries living in Lima) adopted her, and she was given hope, and in every way a new life. She was transformed by the love of this family, eventually finding faith in Jesus and was further transformed by the gift of forgiveness, eternal life, and a sense of purpose and hope. She married and had 3 beautiful children, each of whom are now professionals -a doctor, dentist and lawyer.

an example of the ¨Cerros¨in the outskirts of Lima

She was walking by some street children one day years later (when she was in her 40s), and was siezed with conviction as they begged her for coins, knowing that they were who she used to be. Wilma decided from that moment on that she would devote her life to *seeing* these children who are invisible to much of society, hoping to do for them something of what had been done for her. She began by starting to do bible lessons with them at churches in the area; this led to helping them with food, meeting their families, and more and more loving them with the love of Christ.
This mission gradually led her into the Cerros of Lima, where many of them lived, and she saw their lives of hopeless poverty, and asked God what she could do. She felt led to start a school in those Cerros, to help educate the children, many of whom did not have a school to attend. The Cerros, until recently, were not considered part of the city by the Lima government, because they were mainly inhabited by poor people from the countryside, or other indigenous peoples often marginalized (literally) by the government. She started in a wooden shack, teaching the children about how God loved them, how they were precious to Him, and doing all of this out of her own monetary resources.  This work became too big for her small shack, and she began seeing how powerless the people in that community felt concerning appealing to the government for water, trash collection, etc.  Over the past few years she has been an ardent advocate for the people of the Cerros to have access to water (before, a truck would come up and people would bring theircontainers and buy water as their only water supply), to have roads paved as they are in the city (since it was all dirt and in a hard rain, entire communities could be wiped away as well as the roads), to plant trees - which are now growing bigger with the water supply that the community has due to her tireless efforts.
Her shack has become a 4 story cement building, made by her own hands (literally), brick by brick, using large cement blocks that her husband could obtain from the factory where he worked. It is still in progress, but it is magnificent and a beacon of hope compared to the shacks surrounding it. This center serves as a school, a meeting place for their church, and a symbol of what is possible with God, and faith and perseverance. There are about 100 children involved in her programs, who continue to learn, to be fed spiritually and with nutritious food, and whose families are also being touched by hope and by the Spirit of the LORD who dwells in this place.

Wilma's school - in the center with the banner

At some point along the way, my new friend Clay (part of the team, with Faith Comes by Hearing) met her - I think through the missionary family who had adopted her. He and several others from the US, including David and Stephanie, started visiting her when they would come through Lima, and this year was no exception. I am deeply grateful for the several hours we spent with her, hearing about her work, meeting her children, meeting the children involved in the school/church there, and praying with and for many of them during the afternoon we spent there.
I will post pictures of her and the school when I am home.
She witnesses to the truth that the light of Christ shines in the darkness and the darkness has not overcome it.

Where to begin...

This will be the first of several posts. trying to share bite-sized portions of a very full experience, in places full of memories, now from yet another season.
I am a believer that one´s first impressions, the things that come to mind first when asked a question like, ¨So how was the trip?¨ are very important to notice... of course there are also treasures that surface after reflection and time.  I´ll start with the former, since those are still quite fresh.

Where to begin? I´ll first say that I know many want to see pictures of where I´ve been and what I saw, but the limitations of an internet cafe, with a spanish-based keyboard, and a sometimes-unreliable (or suddenly absent) internet connection make picture uploading problematic. I´m thankful for this moment, in which all seems to be functioning! I will save the picture sharing for when I am home, and am able to gather pictures from other members of the team as well.

Chronology is important to me, and especially since I didn´t know the details exactly prior to leaving, I´ll start by sharing some of the basic framework for my time, which will help later to fill in with more stories and pictures.
The people: Our team consisted of David and Stephanie (brother of Kathy, my doctor friend, and directors of Renew Ministries, have been working with the U* for 10+ years)), their 17 yr old, delightful son Josiah, Clay (VP? of Faith Comes by Hearing, master of fixing things, and long-friend of the U*), Lee and Sarah (a young couple who work for Renew Ministries, in charge of logistics), Kathy (doctor from Duluth), Anny (from the DR, now living in Iquitos for 7ish years and working w- the U*, also the team logistics), a team of 5 young men from the DR [Dominican Republic] who helped with mens' ministries/teaching, futbol, and preaching; Elliot and Alexa (a couple involved in education & agriculture, currently training with Echo Ministries which is worth looking up! they do amazing work with sustainable, resource-appropriate agriculture in developing countries), Jerry & Kathy (missionaries with LEI, the ministry my Great-Uncle Robert Rice started to teach literacy through simple bible stories), Alexia (a Peruvian dentist connected with iTech organization), Jazna (architect from Peru who has recently trained in bible translation and will be working with the U* on various things. she was the amazing childrens coordinator during the week, for 60+ kids!), Bridget -a RN from the UK now living in Nauta, who felt called to join this work, and has been there 1 year, working with the U* (she proved to be a dear sister, and was a huge blessing to me!), a father/son pair from Maine who were there for a month visiting Crystal - also from Maine, who has been living in Nauta for several years, serving in various capacities and with our team was invaluable as a translator (english to spanish) & pray-er.
We joined the Peruvian (Iquitos)-based team led by Pastor Marcos, a Brazilian pastor who has been shepherding and discipling the U* believers and leaders for the last 10 years, and his amazing staff of about 10 Peruvians who did much of the cooking & cleaning for ... 200+ people every day! 
The U* people numbered about 175, far more than were expected, but the LORD knew exactly who needed to be there, and we trusted that.

The times and places:  
We began in Lima, arriving deep in the early morning hours of Sunday, and after too little sleep, went to visit a long-time friend of this crew named Wilma who works in the ¨cerros¨outside Lima... these are the hills, but don´t think of green, lovely hillsides.  They are barren, water-less until recently, dusty, desolate aside from the thousands (?millions) of poor Peruvians who live there, eeking out an existance. Wilma will have a post of her own soon.
Sunday evening (3-3-13) we flew out of Lima to Iquitos, the bustling city at the headwaters of the Amazon where I´ve spent more time than anywhere else in S.America. Upon arriving, I was met by an old friend John, who I know from my time there in 2006, and we were able to have dinner with Dr. Ronald who I also worked with during March 2006 (see prior posts from that time if interested!).
Monday morning we went to Nauta (2 hrs by bus), all 24 or so of us, and then boarded a lancha (boat) for Aurora - the ¨camp¨ where we would meet the U* and spend the next 3 days for their annual meeting. Aurora is a property owned by David & Renew Ministries that is intended for equipping and training for the U*. They don´t live there, but have met there for the last 4 years, gradually accumulating more people from the 40 U* villages, who are interested in learning about God, growing in various areas, and having an annual ¨meeting.¨  The 175 U* stayed in cabins at Aurora. We stayed up the Rio Marañon about 15 minutes by boat at an Eco Lodge, which was amazingly comfortable, and not super jungly at all. We were blessed!

Impressions:
> The jungle and Amazon basin are amazing parts of the Lord´s creation... lush, vast, deep, teeming with creatures, and home of some of the yet-unreached peoples on our earth. Those peoples, which include the U*, are amazing in their history, cultures, ability to survive in ways of which we have no understanding.
> The Lord is able to make Himself known to people who don´t read, who don´t have a church building to meet in, who have never before heard of Jesus or a Loving, Strong, Almighty Creator-God. ... And He is doing just that among the U* and no doubt other peoples.
> Our team was an incredible collection of talents, a real picture of the Body of Christ, in all its different functions. I thoroughly enjoyed working with them all!
> Being in Iquitos felt very natural and familiar, and was especially sweet because I was able to visit with my 3 main friends from the month I spent there in 2006 - John, Ronald, and Nimia!  They warmly embraced me, we caught up, shared 2 meals, and were able to reconnect easily after 7 years.  Also in Iquitos, I spent time with Jerry and Kathy Manus, the LEI [Literacy Evangelism International, now directed by my cousin Sid Rice] missionaries who have been in Peru for 19 years, mainly working with the U* and just recently beginning to teach literacy to the women U*. My cousins Sid and Christa Rice had asked me to try to visit the Manus family if possible when I was in Iquitos... better than that, I worked near them daily, operated¨on Jerry´s toe (which had a minor infection), shared meals, and had coffee at their house at the end of the week.  It was a beautiful gift from God to have such sweet connections!
> My Spanish skills were well used, and feel more and more accessible.  This has been such a blessing, and I just love this language, and the people who speak it. I´m so so so thankful for the investment I made 7 years ago (spending 3 months in Latin America) which continues to bear fruit.
> Equipping and empowering are tricky, and hard to do well, without "adverse effects" ... I have a lot of thoughts about this, which need more time to simmer.  Toxic Charity is a book I´d commend to anyone who wants to delve into the issues surrounding how we do ¨charity¨ ... but be warned: it will be potentially uncomfortable and very challenging.
> I  love connecting people...  I so enjoyed introducing my Peruvian friends to the team, especially Bridget, Anny and Marcos & co. who live in Iquitos/Nauta and potentially fostering some cooperative efforts between their works. My friend Dr. Ronald with whom I worked for 1 month in 2006 is now the Director for Amazon Hope, a medical boat outreach into the deep, remote jungle villages, offering medical & dental care to their inhabitants. 

I´ll stop there for now. If you´ve made it this far, well done. More to come, in story-form, hopefully soon if the connections remain.  Thank you for your prayers and interest. Until next time...
Çiao!

There and back again - literally

So it's been some time now since I've posted but due to the miracle of the internet and blogs and cyberspace, it's still here...  waiting.  I've decided to fire up the old blog again, because the time is right.

I am returning to Iquitos, Peru on March 2, 2013 to work with an indigenous people group in matters of health promotion and needs assessment. It will be unlike anything I've ever done and yet hopefully the beginning of what I'd like to do more of: serving as a consultant, a listener, an adviser, and an empower-er of others.
For some who are coming to this blog for the first time, you may wonder about the title: There and back again.  It has several meanings/origins. 
One - it is unashamedly and humbly borrowed from JRR Tolkein in the Fellowship of the Ring, which holds beautiful images of our journey toward Distant Shores and the struggle between dark and light along the way.
Two - I started the blog when I was traveling to 3 different countries in 2006, Guatemala, Ecuador and Peru, and the name seemed so apt, since I was spending a month in each country and would return after those travels to begin my residency. I have used it since for various other trips (Bolivia, Niger) and happenings.
Three - now I very literally am going back to one of the spots I was before (Iquitos) ... again! 

I had no idea at the time, in March 2006 that I would return in this context in March 2013, as an assistant professor of Internal Medicine and Pediatrics, Core Faculty in the Global Health Department at the University of Minnesota and recently awarded a Certificate of Knowledge in Tropical Medicine... all of which have only come about within the last year and by the generous, wise, kind and providential designs of the Wonderful One. 

So I will be posting as possible during the next few weeks regarding my trip, the team, lessons learned, thoughts and musings. 
Thank you for reading - it's nice to be 'back again'.

Iquitos Peru at the headwaters of the Amazon River