Pictures from the recent past

At the ice rink with the family n' Dustin




Dustin and I at Cannon Beach

Dustin and I hit the trail for a bike ride on this beautiful February Saturday!

4 months ago

wow--I realize that it has been 4 months since I last blogged. It seems that blogging kept appearing on my list of things to do, and now I'm finally doing it.

What's happened since last October? A lot of things, as you can imagine.

a peek at January/February--

To add a little variety to the daily mix of running/biking to and from school, I started playing on an intramural volleyball team at our school rec center. It's been really fun to be hitting the ball again, and a great way to connect with classmates outside of the lecture hall.

Dustin and I celebrated a year of our relationship together on Valentine's Day with an outing after a long day at school to the Spaghetti Factory on the riverfront and a fun movie of "the Absent-Minded Frofessor" which is now known as "Flubber." We're both big fans of old Disney movies (not the cartoon type but the silly ones with people that Disney keeps re-making)--good for clean laughs, and sometimes they are just utterly ridiculous.

I had the opportunity to again be on the worship team for our CMDA NW Winter Conference in Cannon beach, only this time, I was co-leading/organizing with my housemate Julie, who played cello. We had the task of picking out music for the retreat (so difficult because there is so much good music out there!), organizing practices, and then of course, leading at retreat. We had quite the worship team--guitar, piano, djembe, bass, cello, and violin and vocals. It was a really nice weekend (despite the grungy weather) to relax at the beach, hear some good talks, and the Christian conference center there serves phenomenal food! It was also of special significance to me because that was where, a year ago, Dustin and I started to really connect with each other.

Other than that in school we are finishing up our course in neuroscience, which is really a combo of neuroanatomy, neurology, and psychiatry. It's been fascinating!!! There are probably 10^12 neurons in the brain, and each other them has a special set of connections all over the brain and some outside the brain. No wonder it's hard to replace them once you loose them because even if you could put the neuron back, it may not make the connections it needs! It's also been neat because we've had patients with different neurological diseases come in so we can ask them questions and see their exam findings (Parkinson's disease, Huntington's disease).

I finished up a preceptorship in emergency medicine. It's a very interesting environment--fast paced, lots of variety, but also kind of chaotic. I had a great teacher and I got lots of opportunities to use the medical knowledge and skills I have learned so far. And I was consistently reminded of how far I am from where I will need to be..there is just too much! Our third year of practical training is coming up fast--we will soon move out of the safe classroom environment into the clinics and hospitals to interact on a daily basis with patients and actually enter into their care. I'm nervous and excited--it's going to be lots of hard work and hours, but the excitement of really learning the practical skills and art of doctoring will hopefully make up for it. We'll do rotations in teams, in everything from surgery to obstetrics to family medicine and psychiatry. In addition to looking towards third year, we're gearing up to take the USMLE (the first step in becoming a US liscensed physician). This is a gi-normous test assessing our knowledge from the first 2 years of medical school. I have a hard time remember what I learned last block, nonetheless from the beginning of anatomy last year! That's why they give us a month to study our brains out in May/June. Oh joy--more sitting at a desk! but it will be neat to finally bring all this knowledge we've acquired together and very humbling to realize that all that knowledge has been so quickly forgotten.

I was also blessed with the presence of my parents in January--they came and stayed at my house. It was a new experience for them to come and have me "play hostess" and cook for them and take them around town. Last weekend I visited Jess and Derek and Cynthia in the Eburg for a relaxing weekend of hanging out, watching movies, and enjoying a beautiful walk up Manashtash ridge overlooking the valley with a great view of the snow-capped peaks.

Whew! And that's only January/February!

November/December had the usual visiting of family at the holidays and enjoying good times together there. We had the entire Teeny family to our house for Thanksgiving--wow, that was a lot of people! Also had some fun birthday-action with Dustin and I's birthdays being pretty close together; this included a delicious cranberry cheesecake, and a candle-lit picnic in the back of a truck. My family also enjoyed a snow-shoe adventure up near Snoqualmie on Christmas Eve with our new snow shoes that we got for Christmas. On New Year's Eve I ran P-town's "First Run" with 2 of my housemates. Basically you take off at midnight downtown--it was quite cold, but I ended up running my fastest time for a 5K which I was proud of.

Hm...well, I'm sure there's more I could say, but I need to hit the sack so I can make it to class with some assemblence of awakeness.

final goodbye to summer

Well, the votes are in: summer has finally ended, the cold fall rain is upon us, and I think I went camping for the last time this year last weekend (I kept thinking, ok now I will finally wash my sleeping bag--but then I just kept going camping again and again...). For reals, we are back to school--in fact, we've already had 2 tests (going on #3 this monday). It was kind of sad once the summer ended because it was probably THE MOST awesome summer ever--the first time I didn't work in many years, and I just played and played. But then, I also had no cause to complain in coming back to the grindstone. I probably camped more than I ever have in my life in one summer and spent as much time outdoors as possible. I even had a weekend to go backpacking with dad--an annual tradition now since I was about 12 years old. This time we went up to Mt.Hood, which was very cool and would have been even more awesome if it didn't rain (we saw the mountain for, oh, maybe 15 min...the rest of the time it was socked in). It was wonderful to have some daddy-daughter time, and even though it was miserably wet, dad and I wore super rain gear (i.e. bright yellow firemen-type pants=dork!) that kept me reasonably dry and the rain kept away any neighbors. The wildflowers up at Paradise Park were spectacular as well.

By the way, I am loving my housing arrangement for this year!!! I live in a house with another Christian gal from my class and then a Christian couple, the husband who is in my class and also my co-CMDA leader. We have house dinners once a week and sometimes spend evenings jamming on our guitars together. My commute to school isn't bad -- in fact, downright refreshing sometimes to bike or run to school. CMDA has been really great. We started off the school year with a breakfast-FEAST bonanaza at our house followed by a hike at horsetail falls. We've also had a great response at our weekly Bible studies with students and even staff from various departments/schools. We're studying the life of Peter right now, and it's been really great to get into the mind of disciple and watch how he was transformed by Christ. A few weekends ago, Brian, Julie, and I led a camping trip for a CMDA retreat on the coast. It was a great time for bonding with other students/residents over fire-baked potatoes, hot homemade chili, smores, and a hike along the bluff. We're looking forward to what God is going to do through and in this group this year!

A few weeks ago I went to San Antonio, Texas with a local doc to lead worship at a WIMD (women in medicine and dentistry) conference. WIMD is a ministry of CMDA; at the conference it was so encouraging to see so many Christian women in medicine. I heard some great talks, ate good food, and met a lot of amazing women who love the Lord. Leading worship was fun too--I practiced a lot this summer for the worship part, and I think people really enjoyed the music as did I. There were a few other lady docs who we added to the team who were great musicians too.

You mustn't think that my life is all play and no work. Indeed, school has started...I just kept playing, and added the studying part. I joined the annual Teeny luau on the harbor for labor day, which I hadn't been able to attend in years (even did a little karaoke). Like I mentioned, I've been camping even since school started (we have about every-other-weekend to play and not worry about a test). I also went to a wedding. It's crazy...all of sudden my friends and family are getting married; I must be getting old?

So what have I been doing during the 4+ hours I spend at school each day? This year started out with pathology--i.e. "when stuff goes wrong," particularly in the heart, kidneys, and lungs. It's been pretty interesting now that we're finally learning about what really goes on when we say "heart attack" or "v-fib" or "renal failure". Most of this stuff I knew close to nothing about before med school, and we get to use some cool tools--like we practiced doing echocardiograms (heart ultrasound). My housemate, Brian, even brought a portable ultrasound machine home one day and ended up playing with it for hours! I also have a new preceptorship for this quarter (last year was family medicine): pediatric oncology/hematology. People always respond with "whoa, that must be hard." Indeed, there are definitely some things that are hard for me to see and that I'm not used to seeing, like poor little babies hooked up to tons of machines and kids who stay in the hospital for a month at a time. One evening after preceptor I had such a hard time--I was crying at seeing their suffering (and the parent's too), not because I thought that God was terrible for putting them through that, but because I feel like maybe that's a tinge of what God feels when he sees his kids suffer. But there's also a lot of hope--those babies wouldn't hardly have a chance at life if not for those machines, meds, and nurses, and same with those older kids. ALL (acute lymphoblastic leukemia) has almost a 85% chance of cure with some types. And it's great when you see them smile and laugh--very cute for sure. So the docs do a lot of counseling with parents, and it's very interesting to hear about all the complicated medical stuff that goes on too. In short, it's a good quarter so far, and it's definitely making me think more about doing something that involves pediatrics. I'm taking an elective right now that introduces all the major fields of medicine to help me in my process of figuring out what I want to do with medicine, which is a pretty big question that won't be resolved for awhile.

It's raining now, and I enjoy the pitter-patter outside my window. Makes me feel all warm and cozy...

Medical Mission Trip to Papua, Indonesia

I am finally writing up my trip to Papua and posting some pictures and videos! I will try to give the highlights and some of the things I have been thinking about, but obviously there is so much one could write about when traveling to a new and interesting land. Hopefully the subtitles will help you pick what you want to read about.

Dr. Julius and the Luke Society: Our connection to Papua
Our trip to Papua, Indonesia is the result of a working relationship between Dr. Julius Surjadi (Indonesia doctor) and Dr. Steve Baker (an American family doc) through the Luke Society (http://www.lukesociety.org/), which pairs up Christian North American doctors and business people with Christian healthcare workers in developing nations who have a vision for reaching their own people, but need some further support on making the vision happen. The North American workers pledge to pray, visit, and support the national doc as they do their work. Dr. Julius' mission is to reach the interior tribes of Papua with the Gospel and medicine by training national Papuan evangelists from the interior in basic healthcare skills to bring with them to the unreached tribe they are settling in. These villages are very remote, unreached by the outisde world and so have remained virtually the same for thousands of years. They have no modern technology (electricity, running water) or the Gospel, and sometimes no written language either. Dr. Baker began SMI (summer medical institute) as a way to engage healthcare students/professionals in serving the poor for Christ and serving cross-culturally, but also to help Dr. Julius, who spends most of his time training rather than doing clinics himself. By bringing in a short-term team to do clinic in the remote areas, Dr. Julius and the local evangelists gain more time for training and crediblity with the locals; which are important for maintaining the long-termwork there.

It takes a long time to get there...
We spent over 40 hours on planes plus transit time to get to Sentani, Indonesia, which is like the Sea-Tac of Jayapura (the capital of the province of Papua). Papua is located on the island of Papua New Guinea, but is a province of Indonesia rather than the independant state of Papua New Guinea which is on the eastern half of the island (confused yet?). It is right on the equator, and therefore extremely hot and humid, and the days last from 6am to 6pm pretty much all year round. By the time we finally landed in Sentani, I was so exhausted and jet-lagged--I didn't know what time I was in. We spent the first day recovering in "Hotel Rata" and waiting for our "surat jalan" which are "walking papers"--i.e. even though we had visas, because of politcal unrest in Papua, the government requires foreigners to carry extra permission papers. I ended up sleeping most of the day, and then in the evening we had dinner together on the roof. A Christian missionary joined us who is working with tribal peoples to create public health messages (in the form of stories since this is a story-telling culture) in their own languages with native music. For example, she showed us one they are working on for AIDS, as that is a new epidemic in Papua and yet there is being little done to educate people there. We also met up with Pastor Sumiren (Soo-me-ren), a local Indonesian pastor who helped our group with connecting to the village we would do clinic in. He recruited some of his parishoners to help us with translating and cooking, and a few of them also joined us. This group of young people turned out to be invaluable to our work there, and we so enjoyed the sweet fellowship between believers and working right alongside them to serve the poor.

Sentani Lake Clinic: The Needy Village of Barbronka
The next morning we packed our bags and trunks of medicine and supplies into vans and headed to the boat launch area where we crossed the lake to a village called Barbronka. The boats had a small outboard motor and could carry a fair amount of weight. The fishing boats however, were a single hollowed out tree that looked like your bottom would barely fit in and looked tippier than any canoe. The village ran along the shore, as most of the houses were built on stilts over the water. Without sanitation, the shore water was pretty disgusting--hogs swimming around, chickens scratching, thick algae, bits of trash, and whatever other kinds of waste. We all slept on the floor of a big open platform with a roof to keep the rain off. Our bathroom had been made for us--a little tin shack over the water with a hole in it so that our liquid waste went...right into the lake. It was also where we bathed by dumping water over us--a bit chilly, but refreshing because the it was so incredibly hot and humid we were sweating all the time.

Before opening clinic that afternoon, we had "opening ceremonies" in what appeared to be the village community house--a plain building with concrete walls that went about 4 feet high and had no doors which also would serve as our medical/dental clinic and pharmacy. The district chief and village chief each expressed their thanks for us and to Jesus and explained to the curious onlookers what would be happening in the next few days. They also talked about how they had no access to healthcare, except that a public health worker used to come once a month for the women and infants. We began a busy clinic that afternoon with our pharmacy, dental team, and medical team trying to get our footing. We had a few translators, but as best we could we tried to use Indonesian directly with the people. Talk about language immersion! The first day was a bit frustrating in parts because I felt so inadequate as a medical student-playing-doctor, but thankfully Dr. Baker and Dr. Julius were right by us to consult with and help us. The language barrier was also challenging to work with, in addition to cultural differences. For example, it is inappropriate to give things or touch people with only your left hand (due to sanitary practices)--kind of hard for someone who is left handed to remember! People were always watching us too--us curious-looking white-skinned people! We saw so many men, women, and children--3 medical stations in one open room plus a dental station. The patient would hand us a card with their name and chief complaint written in Indonesian and we would go through our algorithm and try to determine a diagnosis and treatment. It was a very different style of doing medicine than I was used to in the US: here we had no lab tests, X-rays, or CT scanners, physical therapy, a limited supply and range of medicines, and no charting or rules about HIPPA or official prescription pads. The range of disease was somewhat similar--a lot of people with chronic joint or back pain (which it is NO WONDER since they do tons of physical work just to survive), upper respiratory infections, ear infections, GERD. But we also saw many illnesses that we don't see much in the US except perhaps among the very poor--malnutrition, worm disease, fungal skin disease, scabies, yaws, machete wounds and open/infected wounds (again, related to lifestyle, poor sanitation, not wearing shoes!), malaria, and even a possible case of leprosy. It was sad when we saw things we couldn't treat--a few cancers, TB, club foot, and other illnesses needing surgical intervention. We couldn't address very many chronic care illnesses which we didn't even screen (for like HTN or diabetes) because they require long term medications which without a doctor/nurse in place could actually be dangerous to treat if medications were not controlled. Instead we focused on what we could help with. We even were able to help by testing eyes and providing reading glasses, which was really fun. By the end of our third day of clinic, we had seen 568 medical patients besides dental, and people had come from other villages to receive care as well!

Our daily lives were pretty simple: we arose early in the morning to a spectacular tropical sunrise over the lake, began sweating, ate breakfast, had group devotions/worship, and began clinic work until 5pm that evening with a break for lunch (while sweating). After cleaning up clinic, we would chat a bit, and then have dinner, bathe, and collapse underneath our mosquito nets to begin the same thing the next day. Our last evening, the dental team put on a short interactive presentation for all the children of the village about cavaties and brushing teeth, and then handed out toothbrushes. While we were there, we feasted 3 times a day on good Indonesian food--lots of fish, the best banannas ever, oranges, chicken, and LOTS OF RICE...every meal...there was no cause for hunger unless you decided not to be very adventurous and try the delicious yet sometimes suspicious-looking foods. We even had "sago" one time--a staple in Papuan culture. It is this wood from the sago tree that is ground into a pulp and then cooked down or made into flour. The traditional way to eat it was quite interesting--basically it forms a big sticky GOO, like orange glue with very little flavor but you add broth to your bowl to give it some. Of course, I tried it--but needless to say, I could do fine without ever eating it again.

Why go? Serve and learn...
You may be thinking: things sound pretty rough, why even go? These poor people were in great need of healthcare, and it was such a privilege to come and serve them in even simple ways. Matthew 10:42 in the Bible talks about how "if anyone gives even a cup of cold water to one of these little ones because he is my disciple, I tell you the truth, he will certainly not lose his reward." Matthew 25 also talks about how when we do simple acts of compassion and releiving suffering, "whatever you did for one of the least of these brothers of mine, you did for me." And so though it may seem like all we offered was "a cup of cold water," the people were so appreciative to have someone to care for them and we were able to serve Christ by doing this. There were many blessings in serving these people. We were able to do these clinics openly in the Name of Jesus, and we prayed with nearly every patient for both their physical needs, family, and spiritual needs. What an opportunity! for all of us as well to learn about the joys and challenges of serving Christ by serving the poor. Papua is an island that most people do not want to be sent--the Indonesian people (straight hair, tan skin) tend to look down upon the Papuans (dark skin, curly hair, aboriginal type) because they are viewed as backward, and kind of stupid, like they are a lower caste. It was the Indonesian peoples that took over the island of Papua. And so by going there to serve the "lower caste" of society, we were helping fill a gap that no govt. or even secular group is filling as far as I know. I learned about depending on God more: so much of our medical care is that we depend on God for only the hard stuff--the cancer, the hard-to-treat, the difficult patient. But there--every person, independent of their physical ailment or treatment, was given an opportunity to receive prayer/spiritual care for that physical need because we recognize that Jesus, the Great Physician, is really the one who heals. Sometimes prayer was all that we could offer them. And they were glad to receive it! But really...Jesus is all that we really need. Sure--God chooses to use our medical knowledge and drugs to benefit people too, but it's still a good idea to realize that truly He is the one who sustains us. That is something that is very hard for us who have so much to realize.

We also learned a great deal about the challenges of cross-cultural care--something we will all encounter in our careers, whether it is with our co-workers or patients. Sometimes there is a language barrier to deal with, and most times there are cultural beliefs or practices that change the way you approach medicine.

Another thing I enjoyed so much was the encouragement of fellowshiping with other believers who, though speaking another language and being from another culture, had the same Spirit of God in them. What a joy to hear them worshipping and praying to God in their own tongue and in their own style. A literal taste of Heaven!

Moving to higher ground: Wamena, Pyramid, and Bogapa (transitioning to the highlands)
On Friday morning, one week since leaving the US, we said our good-byes and made our journey back across the lake to transition the next day to the mountains. Friday evening we spent at the sponsoring church (in the dark and sweltering heat because the city shut off the electricity) giving a presentation about the trip to Christian medical Papuan medical students and visiting with them, with the goal of getting national students to come on this trip so that they will catch the vision of serving their own underserved people. It was exciting to for both nationals and us to meet Christian med students and fellowship with them as well.

The next day was spent trying to get out of Sentani. There are 2 flights per day to Wamena, one of the largest cities in the world that is only accessible by air travel. The first flight was delayed 5-6hrs due to cloud cover, and then we finally made it out on the second flight. In the process, I slept on the airport floor, as I had taken some medicine due to having bad nausea. We also listened to Pastor Sumiren's testimony which was very inspiring. Over and over again on this trip we listened to people tell their stories--and every time it involved 2 principles "trust and obey". That is, submission to God's plan was a huge part if not the determining factor for why they were in Papua in the respective posts.

After arriving in Wamena, we were escorted by a Christian Indo-Chinese businessman to his house where we spent 2 nights. Joseph and his family have a vision for ministering to missionaries on their way into the interior by providing housing for them, and so he graciously allowed all 14 of us to stay there! In fact, God has blessed their business so much that he is building a whole complex of rooms for people to stay in. They were wonderful hosts, and served us great food too--including "pre breakfast" of fried veggie pastry and fried banannas, coffee, and tea! wow! Also interesting was how they honored the Lord in their home by placing big flourescently lit "Jesus" pictures and signs on their walls. To us it would have seemed tacky, but they were so proud of the big Lord's Supper picture with big colorful Christmas lights around it.
Saturday evening was spent with Kim Dugger, a long-term missionary from America who has just set up a mission clinic in Wamena. The group got a tour of the place, and he showed them some very puzzling medical cases. In the evening, his wife and child joined us too for a wonderful dinner and time of sharing about cases he'd seen and their story of how God brought them to Papua. Amazing!

Sunday we went to church with the host family in a big building, probably Dutch reform. What was so funny was that we were all prepared for 2-3 hr services (often the case outside the US), but it was only an hour! And they sang some old hymns that had been translated to Indonesian. Thankfully I knew some of the words, so I could sing along too. That afternoon we traveled about 90 minutes outside the city to a village called Pyramid, where some missionaries from MAF (mission aviation fellowship) were having a retreat. It was neat to meet up with long-term missionaries, and also get to enjoy being outside in the countryside again. Rose, one of the MAF pilot wives, helped us buy local crafts from the crowd of village people surrounding the camp.

The next morning we left Wamena by small plane (piloted by MAF) to Bogapa and then by helicopter (Helimssion) over tall mountain peaks to Bubisiga, which was our final clinic destination in the remote highlands. It was amazing to look at the green hills and mountains we were flying through and see huts out in the middle of nowhere! No roads in sight! The mountains were very craggy, and tall--16,500 is the highest peak, and contains Papua's only glacier which is pretty amazing considering we were on the equator. We had a quick stop in Bogapa--another mountain village, but one that had an airstrip.

Bubisiga: Medical care and back to the basics

We arrived by helicopter to a small village tucked away in the mountains and jungle, only a short flight by air but hours to days of travel by foot. It was an amazing sight--a hundred men, women, and children gathered around and greeted us. It was like stepping into a National Geographic article--complete with decorated naked men wearing gourds toting their bows and arrows around, thatch huts with the smoke seeping out the top, and children with bellies distended from malnutrition. The village had a tribal pastor, who welcomed us and showed us their prized church building--complete with a tin roof, low wooden planks for benches, and Catholic-style posters of Jesus on the walls. The church and the volleyball court were the centerpieces of the village. We quickly tried to settle in so that we could run a short clinic that afternoon, so we started filtering water and cooking Mountain House (freeze dried food) for lunch and tried to figure out where we would hold clinic. That afternoon the dental team set up under a tarp, and the medical team created a semi circle of stools and wood planks for patients and doctors to sit on. This was defintely clinic-in-the-rough! It was defintely challenging at first during clinic because we had 2 translations going on: English to Indonesian (in our heads), then Indonesian to Moni (tribal language which the evangelists helped with), then back again. Thankfully our time in the lowland village was good preparation for a more simplified (because we followed the algorithm closely) but circuitous interaction. Sometimes we just had to ask the same question over and again until they answered "ya" or "tidak", to keep it simple. We also prayed with our patients here, and worked right alongside the evangelists, who also worked in the pharmacy and gave lots of shots. Oh that's another thing that's different: they not only like shots (suntik) when they come to the doctor, they expect to get one!

By the end of our short clinic we had already seen almost 50 patients. We then ate our evening meal and crawled into our tents to rise with the sun the next morning. The next day I decided to venture into the "bathing area" for a very cool but refreshing dip. The natives had been told by Julius that we needed some privacy for bathing, so they built a little fern wall to wall-off a small pool with a stream running into it. Unfortunately, the main trail went right over the top of it so that people could easily peer down into it! I don't think the natives took the opportunity to be voyers, for which I was thankful. They also built us a little 3 walled latrine (a hole in the ground) from ferns and sticks -- I was continually amazed at how resourceful the people were!!

Before beginning clinc, the tribal pastors and ministers held a church service dedicating the clinic. It was so awesome to see the whole village be called into church, men (some just wearing gourds!), women nursing their young, children, and elderly until the little one-room church was packed to the point of people sitting in the aisles! They spoke in Moni, so we couldn't understand them, but we tried to sing along to their tribal worship-music anyway. When that was ending, one man stood up and started yelling about something. It turned out that when the cheifs found out that we were only there to do clinic 1 more day, they were not happy because people were walking from over 10 surrounding villages to be seen! It was almost like a cry for desperation because they have so few resources--they were demanding us to stay longer, which we could not do unfortunately. Thankfully, God gave Dr. Julius wisdom as to how to negotiate so that we could get clinic started again. I looked out into the village and saw a multitude of people milling about--far more than were there the day before. I felt perhaps what the disciples thought when they saw the multitudes of people listening to Jesus, desiring healing and teaching and hungry and all they had to offer were 5 loaves and 2 fishes. But God was able to help us work efficiently and quickly so that we saw over 150 patients that day--more than they had ever seen in the highlands before!! Again, some of it was very sad for the complicated infections or deformities, knowing that they would probably not have access to the care they really needed. But it was very satisfying to help those that we could. Dr. Julius also used the afternoon to train the tribal evangelists in medicine and give them a whole pile of basic medicines to use! How awesome to see Dr. Julius working with those who are making real lasting impact in the villages. At the end of clinic, the village people taught us some things from their world: how to start a fire (without matches of course!) using bark, how to shoot arrows (they laughed so hard at our failed attempts to shoot their dud arrow), and took us on a tour of their village. In fact, Brian and I took the opportunity to sleep in a honai (traditional thatch hut) that night! Brian stayed in the guy hut and I stayed with the pastor's wife and kids in their hut (men and women sleep in seperate huts). The huts are really neat: they heat them with a fire in the middle and the smoke seeps up through the roof (hence, stay low to avoid being smoked out), and there are two walls to insulate the room, with a woven wood floor elevated above the ground. I was amazed that we stayed completely dry despite the rain. It was so awesome to stay in the honai because it was entering into a more intimate part of their world, and I was able to "talk" about basic things (where I was from, marital status, foods) with them using the bits of Indonesian I knew and a lot of sign language. They also played their mouth harps called "bigigi" and offered me bits of their food: sweet potato, sugar cane, greens, and some root I've forgotten the name of. It got a bit cold in the night when the fire got low, but I don't know how the people survive just in their bit of clothes with no bed or blankets! One of the other "nona"s (single girl) ended up cuddling with me...kind of interesting.

Timika: Rest and the long journey home

Wednesday was our transition day out of the mountains. We packed up our things and helicoptered back out to Bogapa where we transferred to small plane to fly to the southern city of Timika. In Timika we had some time to rest at a Indonesian "resort" (more like a nice hotel...ie. hot water and a pool!). We spent some time as a group debriefing and sharing about what we enjoyed, what was frustrating, and suggestions for next year. One of the best parts of our debriefing time was to hear the testimony of Dr. Julius and his wife Debbie who are an amazing couple that are completely submitted to God in their marriage, family, and work. Of course, it didn't start there, but the process of them coming to Papua was literally an act of God. And God is richly blessing their work--the only of it's kind in Papua. It was also neat to hear from Hiya, the first Papuan medical student to join us on this trip. It was quite an eye-opening experience for her, having never been in the remote areas of her own country and not having practiced medicine in a rural area like that before. She was so inspiried to tell her classmates about what God did and what the experience was like--I pray that not only her life would feel the lasting impact, but that other people through her would be inspired to serve the Papuan people. On Thursday we flew out of Timika--a miracle almost! Airline security and rules are bit different in Papua, and for some reason there was a hole in the landing strip which nearly prevented the airplane from landing (acutally, the airline wanted to land but the airport said no). Then they were supposed to have it patched by a certain time in the afternoon, but by 4 hrs before our flight time we still didn't know if we would actually get on that plane. The downside being that this flight happens once a day and missing it would throw off a delicate schedule of flights. We prayed, and thankfully made it on the plane with only a small delay. That night we spent in Jakarta and the next day we briefly traveled around Jakarta bwith a church friend of Dr. Julius'. Then we flew out to Kuala Lamur, where we also had another overnight layover, and then finally to LA and PDX. Whew! We were glad to get on the ground and stay there! I thank the Lord for a safe trip and that we all got where we needed to be--it was kind of dicey for bit in KL because of some airline mistakes which almost left half the team behind. After many hours in the plane...we finally landed in PDX and saw our loved ones. Praise the Lord for safe journeys and a blessed time!

It has been a tremendous learning experience--one I will carry with me through my career, and a wonderful adventure! I love serving the Lord, medicine, traveling and experiencing a new culture!

Medical Culture Shock

Medical Culture Shock—that’s what I think best describes how I’ve been feeling. It’s funny—I thought I might go through culture shock coming back to the US. But this time it has been focused in the medical world. Since coming to Bandon, I have seen patients be shuffled through one lab test after another, get CT scans, X-rays, and be hooked up to all sorts of technical equipment. Here in the US, we have the ability to look inside someone without opening them up—it’s such a weird thing to look at the person in front of you who is, for example, in respiratory distress, and hold an x-ray of their chest that gives you the key to why they are in such trouble. In Papua, only the big cities had such technology or capabilities for labs. All we had in the remote areas was what we could see with our eyes, touch with our hands, and hear without ears. There were no “routine” lab tests to see how high their cholesterol was, check their blood glucose levels, or count WBCs. Not even a urinalysis. It just makes me think about how much we rely on technology to help us as doctors—and to think about how much is actually necessary? Of course, here we worry about litigation, insurance companies, and peace of mind. There—people have no money, no transportation, but also no ability or knowledge of litigation. Interesting for sure. Then there’s medications—in the US we have a whole host of meds to choose from, but we only had such a limited supply in the field. Charting here has to be immaculate, and there we didn’t do charts at all. Privacy, follow-up, referrals, acute care, preventative care, and even the kinds of diseases were very different. In Papua, it’s likely that few people live long enough to get cancer, and here every woman over 40 should get a mammogram, even immunizations. The disparity is enormous. And yet, we rely so much on medicine to cure us, whereas they must rely on God a whole lot more.

There’s another aspect of medical culture shock I’ve been experiencing and that has to do with Jesus. This whole year I’ve been shadowing a Christian doctor, and I just came off a kind of “spiritual high” by performing medical care in Jesus’ Name and having opportunity to pray with nearly every patient. I don’t deny that the doctors here in Bandon have good hearts—in fact, every patient and nurse tells me how lucky I am to work with this doctor. But there’s something, something BIG missing. I see it especially when we deal with patients who are facing really big health issues—cancer, macular degeneration, depression. These patients need Jesus. I wanted to offer to pray with them, but I couldn’t, so I just prayed silently. The doc I am working with has prayers up on her walls in her office, and I know she cares deeply about them, but a few staff people have already told me to pray for her. She says she’s somewhere between fundamental Christian and atheist, and I’m not sure what that means. I just don’t know how people do such a stressful job like medicine without Jesus as their source. No wonder doctors have such high burnout rate, high divorce, high substance abuse. If Jesus wasn’t with me, I don’t know how I could do this day in and out. I would run out quickly of compassion and patience. I know there’ll be days when I’m short on all those things, but I hope that I won’t ever be angry because someone was truly needing help.

A Week in Rural Medicine

On Monday I drove down to Bandon, OR for a week-long rural family medicine experience. My purpose in doing so was to get a better idea of the breadth of practice family docs can have. My preceptor for this week, besides having her own family practice, works in the ER, follows her own patients in the hospital, and at times has assisted in surgeries, delivered babies and been a hospitalist. She has a beautiful house right on the bluff overlooking the ocean—when I drove up, I was floored at the gorgeous view she has! Tuesday I spent in clinic with her—she primarily has older patients since she stopped doing OB. We’ve talked a lot already about how the healthcare system in is big trouble and how many docs (including her) are fed up with insurance companies and skyrocketing malpractice insurance. Over the past few days I have also been once again exposed to the joys and challenges of serving an underserved population. Bandon is a touristy retirement community mostly, and though it has a small hospital, does not have many of the resources that a large community would have. The ER can only deal with small trauma, they have no surgeon currently, and it seems like people work super hard to keep things going. Yesterday evening I had the opportunity to follow my preceptor as the on-call doc (the only one) for the ER. We've seen some exciting cases– we saw a lady with severe asthma, a woman with a shattered elbow, a woman with 6 broken ribs and then an older man with a pneumothorax. Although I didn’t think I knew anything, maybe I have learned something after all about medicine! Overall, it was a pretty interesting experience, and I’m kind of interested in learning more about emergency medicine.

The next morning we went to the house for breakfast, and rode over to a nearby city so that I could watch a surgery—an inguinal hernia repair. That was pretty interesting, although I was nervouse that I was going to faint because it has nearly happened before. Well…the surgeon had me scrub in and go right up to the table. We were already past the skin and superficial fascia and I was holding the retractors and peering in when all of sudden I knew my body did not want to be there. I didn’t faint, but I felt that yucky clammy feeling, so I went out for a minute and later came back in just to watch. I made it through the rest of the surgery fine, but I was pretty tired by the noon. I think I havne’t had much chance or taken the chance to rest since coming back from Indonesia, so I wonder if I am actually recovered from all that—with the wedding preparations, the only time I had alone was basically in the shower! So later today after a long nap I headed out on the beach and enjoyed a nice walk.

I’ve been learning more about what it’s like to practice in a small town where your patients are your friends too, everyone says “good morning,” and people are more intimately connected. I kind of like that. However, there is some loss of separation between work and home, and there are fewer people to cover for you for vacations and such. In talking with the surgeon (actually, he talked at me), he strongly emphasized “diversifying” outside of medicine and how medicine is changing so much with people moving more and more into high specialized practices and technology taking over. It’s interesting, and I realize in medical school we really need to get more training in how to run a business. I’m not real excited about the business aspect of medicine, and I think balance is very difficult but important because docs are under a TON of stress—many falling into substance abuse, alcoholism, obesity…but I think there’s a big something, no, rather Someone all these people are missing. That is, Jesus. True, even Christians have to be reminded to balance their lives and make wise priorities. They too can be trapped into materialism. I think having the hope of Jesus in our lives makes all the difference in the world on how we can make priorities and go on when faced with difficulty after difficulty. There’s wisdom in what this surgeon is saying, but maybe it won’t be as glum as he says because of what Jesus does in my life—especially in the areas of strength, contentment and true happiness. Oh, I haven’t “arrived”—I am way too young to really know what I’m talking about, but I believe having a foundation built on the Lord will give me endurance and hope as a physician.

A Wedding to Remember

Tuesday the 30th through Saturday Aug 4th was a whirlwind of wedding preparations! I am happy to say that Derek and Jessica did indeed get married on Saturday and the wedding was beautiful. Both the wedding and reception were outdoors at my uncle’s estate along the harbor. Of course, there was lots of stress preceding the actual ceremony, but everyone made it through OK. There were a few moments I really wanted to cry. The first was when Derek saw his gorgeous bride for the first time in her wedding gown. They both started bawling, and I could see that they were so overwhelmed with love and emotion that some of us became so too. I kept having these moments as we were taking pictures where I thought “This is ACTUALLY REAL!! It’s finally happening!” The other moments was when my sister had “Butterfly Kisses” play as we bridesmaids walked down the aisle. As I looked over the crowd back at my dad waiting to escort Jessica, I could see his hands raised and he was crying. You see—this song has been special to my dad for so long. I think it's difficult having to “let go and let God,” even though my parents have been doing it all along with us kids from the time we were first dedicated to the Lord. We’ve been such a tight knit family. My dad used to cry every time he heard the song and then for awhile he kind of got used to it. Then when it actually came to giving one of his daughters away he just couldn't hold it in. Now we’ve just officially added one more, and I’m so glad to have Derek as my bro. I'm very proud of both of them, and love them dearly. It was also so great to see the extended family and friends, enjoy good food, and gaze at the sunset over the water. I also had the privilege of singing at their wedding a song that they asked me to compose. It went well despite some mic difficulties, and I also was accompanied by a djimbe player! The song speaks about servanthood and covenant, which also were two of the things stressed in the marriage sermon. Anyhow, I was also the maid of honor, or MOH and as such had to make a speech at the reception. Well, I've never done a toast before, and when it came time to do it we had the goblets but not the sparkling cider so we just used lemonade--LOL! In fact there were several moments (i.e. the 1st cake cutting) where we kids were asking, "now how do we do this?" I guess that's just the prelude -- we're all discovering how to make it through life and most of the time it seems a combination of other people's wisdom and instruction and a series of trial-and-errors. Thankfully, "where sin did abound, grace did much more abound."

Living up the summer

So it has been 4 weeks since school has been out. What have I been doing with my time you ask? Well, I have been keeping busy for sure. Sometimes I feel like a bum because I'm not actually working at at a job this summer. You see, we only get ONE summer off during medical school, and that's this summer. Because of my trip to Indonesia and other things I'm doing, it turned out I wouldn't have much time for a job anyways, and I think I will be glad that I took the time to really have fun. It has also been nice to spend time with friends and play/listen to music! I have been playing a lot of guitar, and finally got out the trombone too. P-town has a yearly blues fest, and the AF has a concert every year which I went to also. Fourth of July, of course, had fireworks, and there has been lots of other random activities, errand-running, READING, and preparing for my trip too.

I also moved into a new house with my friends from med school (2 of the people are in my class plus 1 is an honorary-med student...i.e. med-student wife). It is a wonderful place and in a lovely neighborhood. I am really enjoying my new living arrangement--especially because we are all friends: we care about each other's needs, can go have fun together, and share the love of Christ. The house is near the river, which has a very nice trail next to it that doesn't allow motorized vehicles. It has easy access to downtown too, and isn't too far from school. We share a nice big living room, 2 decks, dining room, and kitchen, and before I moved in Brian and Julie even put in some carpet in the garage to make a bonus room.

Since I've only been in town for a year, most of which was spent doing school stuff, I've been taking the time to do a little more exploration around the city and be outside as much as possible. Brian and Julie and I a few weeks ago one pleasant Saturday evening decided to go on a spontaneous camping trip--that is, at 6pm we decided to go somewhere and by 7pm we were out the door. I have been camping so much this summer--it is awesome! We headed out I-84 hoping to find a campsite somewhere. Well, we ended up having to keep traveling from place to place looking for a spot. When we finally found one at a state park along the Columbia we discovered why: it is RIGHT next to the train tracks, and so several times that night we were wakened by a blaring train horn! It was probably my first camping trip out with friends (I had always gone with family), first time so spontaneous, first time sleeping out w/o a tent, first time(?) roasting marshmellows over a campstove (we searched for firewood but couldn't find much...the next morning we snagged some from an empty campsite). The following morning we headed to Eagle Creek and took a long hike up to some waterfalls. A splendid time!

I've also been doing lots of biking since there are lots of great trails and roads planned for biking. Sometimes it's just too hot for me to go running, although I've done a little of that too. I've also enjoyed swimming in the Columbia in this hot weather--there's no Lake WA to swim in and I've been hankering for a cool dip. I think I was spoiled growing up next to the lake. I learned after moving here (and after I took a swim in the river myself) that the Willamette is severely contaminated...

Another fun thing I tried was windsurfing!! My bf Dustin is a big windsurfer, and was willing to teach me, so we went out to Hood River in the Gorge and I rented some gear and tried it! It was actually very fun, though difficult and progress was slow, and I can't wait until I get to try again. Gear wasn't too expensive to rent. As Dustin says, once you have gear, all you need is $ for gas and wind...I never would have done it though if someone close to me hadn't been into it.

And now what? I'm off to Papua, Indonesia TODAY!!! The time has finally arrived and I am so excited! I will plan to write stuff up on the blog when I get back. However, my sister's wedding is the following week, so it may actually be a bit before the full-meal-deal gets up.

A great start to summer on the road

Well, I am living up this summer break! So much has already transpired since I last blogged. Time has gotten away from me.

Back at the end of May and beginning of June I did a LOT of traveling around to various graduations and activities. Two of my sisters graduated (one from college, one from high school), and since I live out of town, this necessitated driving quite a bit. Of course, family is worth it. Schoolwise, we finished up the year with more infectious diseases and treatments, now of which I cannot remember hardly anything because my brain has been on sleep mode. On June 15 we had our final exam which was cumulative for the entire course. The evening before was Cynthia's graduation, so I had to drive up north. I had brought my flashcards that have all the wierd bugs to look at while I was waiting. It was kind of funny because I was sitting next to my grandma, and she kept looking over my shoulder reading them too. Anyhow, I was proud of Cynthia for graduating (the last one from high school!), and she was very happy to have had all of us there.

The next day I got up bleary eyed and studied a final bit before taking the final at 8am. Whew! Then the rest of my family joined me for lunch, and we sped off into the east along I-84 to go on our Road Trip 2007 to the Grand Tetons, Yellowstone Ntl Park, and Glacier Ntl Park. What a trip!!! So many strange and wonderful and magnificient things to see--wildlife, towering mountains, mudpots and hot springs, bacteria mats, and geysers. Yes, we saw Old Faithful go off--it was kind of funny because there's this whole crowd of people waiting on bleachers to see it, and at first it tricks you because it's just spurting. Then it goes of really huge for a few seconds. In some ways, Yellowstone feels like a theme park which I didn't really like because it's all touristy and doesn't feel as natural--which is what so amazing because all of it is. Another interesting thing is that Yellowstone keeps changing over time due to the techtonic plate movements. It is an amazingly beautiful place and people come from all over the world to see it and even to work there.

Jess and Derek tag-teamed with us for 2 days to Wyoming. Total, We spent 6 days camping in various places, a few even in RV-type parks which is NOT our traditional style of camping (we prefer more wilderness), but it was fun. We drove over 2000 miles in 7 days, sometimes putting in 12-14 hrs of roving about the parks so we could see things. We weren't originally going to go to Glacier, but we finished Yellowstone in 2 days, and so we decided to drive up there. Unknowingly, after driving through miles of Montana wilderness we find that Going-to-the-Sun road is closed at the pass! Thankfully, we were still able to find a campsite on the east end, and then the following morning drove as far as we could going from that direction, then drove to the other end and followed the road nearly to the pass. The mountains were absolutely magnficient. Unfortunately we didn't have much time to hike around, but just seeing the mountains and waterfalls was beautiful in itself, and we listened to a very interesting bear ranger talk the night before with a lovely campsite looking out towards the mountains. One funny thing that happened was my dad who was the camera-king, dropped his camera in the toilet!! Thankfully he was able to open things enough to let it dry and the pictures and camera function was preserved.

I actually was quite proud of the family for getting along so well. We normally get along really well and love each other lots, but it had been quite some time since we had been in such tight spaces like the magic red van for hours like that. And there was also the fact that 3 of us kids are out of the house now and are used to doing our own thing or going at our own pace. It was probably the last great adventure like that we will have for a while because of where I'm at with my schooling. What a great start to the summer!!!