Every Wednesday at Tenwek, squeezed in between morning rounds and the start of surgeries, is staff devotions. Missionary doctors, trainees, medical students and a few staff attend devotions each week and 60-80 people fit into the meeting room above the OR. Devotions are led by someone different each week. One week might be an intern sharing what God has been teaching him, and the next might be a lesson from a visiting U.S. doctor. Throughout my two years at Tenwek I had the opportunity to lead several times, and enjoyed the ability to organize my thoughts and teach from God’s Word. Two weeks before we came home I had one final opportunity to lead. I was torn with what to talk about. What final parting words would I leave with my friends and colleagues? Could I wrap up two years of my own education into a 45 minute talk? After some thought, I decided to share a few major things that I learned during my time in Kenya. The talk was well received, so I thought I would record in writing a part of it on the blog. Plus, several people here in the U.S. have told me that I need to write more often, so here ya go!!
Imagine yourself as a patient in the emergency room at Tenwek Hospital in rural Kenya. However, you are not yourself, but instead you are a poor Kenyan similar to those seen day after day. Your clothes and shoes are tattered and show evidence of a hard life, just like the calloused skin on your hands and the wrinkles on your sun worn face. Not by any choice of yours, you were born into a poor family. Your dad was an unskilled, uneducated laborer who could never find consistent employment and therefore always had trouble providing for the family. Because of this poverty he was unable to pay for your schooling, so you only completed eighth grade. Without an education, now you too have a hard time getting a job and live day to day as a subsistence farmer. Further education is not a real option as it costs money you don’t have, and you have a family to provide for. The language you speak is Kipsigis and since English and Swahili are taught in school, you understand little Swahili and no English. Day by day you work hard to make ends meet. In addition to your small plot of land, your only asset is your energy and health. Now that you are feeling sick you lose even your energy. Sitting in the emergency room at Tenwek, you find yourself almost completely powerless. You have no energy, no extra money, and you don’t understand English let alone all the medical jargon used around you. You are completely dependent on the medical staff around you and forced to be patient and trust. The only thing in your power is the ability to say “no” and walk away, but you know this hospital is your best chance to get well. So you wait, and look around nervously at the flurry of activity around you.
You look across the room at the group of doctors taking care of you. It appears that their circumstance is completely opposite. They look like they have had enough to eat and you admire their health and strength. Each of them has had the opportunity to expand their knowledge and be empowered through an education. They speak English and the language of medicine, which shrouds your condition in long strange terms that are completely unfamiliar. One of the younger doctors explains to the white doctor “The patient has a sigmoid volvulus that may be ischemic causing a systemic inflammatory response syndrome manifested by an elevated WBC with bandemia, tachycardia, and peritonitis. Therefore an urgent laparotomy is needed instead of a rigid sigmoidoscopy.” The doctors carry cell phones and iPads, as well as wear watches and new looking shoes that give evidence of the power of a disposable income.
At the bedside, there is an interaction between you, the powerless patient, and the powerful doctors.
The powerless meet the powerful and the powerless has no choice but to become completely dependent on the decisions made by the powerful. The powerful has the ability to choose. They can choose to show respect for the patient and use their power to help, or they can choose to exploit the vulnerable in a time of weakness and abuse their power for their own gain.
This power gap is not unique to Africa and is evident in the doctor-patient relationship anywhere in the world. Most of the time patients have no knowledge of medicine, medical terms, or treatment options. Since knowledge is power, the patient is at a disadvantage and the power resides in the doctor’s position. In the U.S. we don’t like power gaps so there are things in place to narrow it and empower the patient. The availability of many doctors in the U.S. gives the patient choice, and therefore power. Most doctors complain about the medical legal system, but the ability to sue empowers the patient by giving more motivation to the doctor to provide the correct care and not abuse the patient for their own financial well being. The fear of being sued, although not the only motivating factor for good care, is a significant driver of quality medical care. Few doctors in Kenya have the fear of being sued, and therefore delays in care are common, patients are abandoned, and sham surgeries are a real issue.
The power gap between patient and doctor has been most evident to me during my time in Kenya. The combination of poor uneducated patients and limited access to healthcare makes them extremely vulnerable. Therefore it is up to us to use our powers for good. We are Christ’s hands and feet in this world and should love each patient enough to put our own benefit aside and treat people with compassion. The larger the power gradient, the more responsibility is placed on the powerful party.
In Matthew 5:3-5 we see that God loves the poor, the meek, and the vulnerable. “Blessed are the poor in spirit for theirs is the kingdom of heaven. Blessed are those who mourn for they will be comforted. Blessed are the meek for they will inherit the earth.” Why does God love this class of people? Because they are not self sufficient, they are dependent, and they are powerless. Their situation in life forces them to put their faith in God and not themselves. Their dependency on Him highlights God’s power and not their own. Isn’t this what God wants for our lives? That I may decrease so He may increase? (John 3:30) Why does the Bible say that it is harder for a rich man to enter the kingdom of heaven than for a camel to go through the eye of a needle? (Mark 10:25) The answer is because the rich man has a tendency to be self reliant, independent, and powerful. In fact, since glorifying God is acknowledging His power and submitting to it, the root of sin is that we want to have power, and are seeking to become more powerful. The reason Adam and Eve ate the fruit in the garden was because the serpent promised them, “Your eyes will be opened and you would be like God, knowing good and evil.” (Gen 3:4) Our pursuit of power thus further separates us from God.
Although we might not realize it, the reality is that we as humans have no power compared to God’s infinite supremacy. The power gap is huge, as He is the all powerful one and we humans are powerless. Just like the powerful doctor having a choice to care for or exploit the powerless patient, God has the choice to love us sick humans or do away with us. Thankfully, Romans 5:8 tells us that “God demonstrates his own love for us in this: While we were still sinners, Christ died for us.”
So, we as Christian doctors need to realize the tremendous responsibility we have in caring for our patients. We should never take advantage of vulnerable people in their time of need. And, for those non physicians, you too have responsibility and power in a variety of situations unique to your life and career. When I talk to a mechanic about my car, his knowledge and my ignorance create a power gap that he could take advantage of. When I need something fixed in my house, the carpenter/plumber/electrician could easily skimp on the job for his financial gain. The ball is in his court.
Because God first loved us, even in our powerlessness, we Christians need to demonstrate the love of Christ to others and act in their best interest when the power resides with us.
Imagine yourself as a patient in the emergency room at Tenwek Hospital in rural Kenya. However, you are not yourself, but instead you are a poor Kenyan similar to those seen day after day. Your clothes and shoes are tattered and show evidence of a hard life, just like the calloused skin on your hands and the wrinkles on your sun worn face. Not by any choice of yours, you were born into a poor family. Your dad was an unskilled, uneducated laborer who could never find consistent employment and therefore always had trouble providing for the family. Because of this poverty he was unable to pay for your schooling, so you only completed eighth grade. Without an education, now you too have a hard time getting a job and live day to day as a subsistence farmer. Further education is not a real option as it costs money you don’t have, and you have a family to provide for. The language you speak is Kipsigis and since English and Swahili are taught in school, you understand little Swahili and no English. Day by day you work hard to make ends meet. In addition to your small plot of land, your only asset is your energy and health. Now that you are feeling sick you lose even your energy. Sitting in the emergency room at Tenwek, you find yourself almost completely powerless. You have no energy, no extra money, and you don’t understand English let alone all the medical jargon used around you. You are completely dependent on the medical staff around you and forced to be patient and trust. The only thing in your power is the ability to say “no” and walk away, but you know this hospital is your best chance to get well. So you wait, and look around nervously at the flurry of activity around you.
You look across the room at the group of doctors taking care of you. It appears that their circumstance is completely opposite. They look like they have had enough to eat and you admire their health and strength. Each of them has had the opportunity to expand their knowledge and be empowered through an education. They speak English and the language of medicine, which shrouds your condition in long strange terms that are completely unfamiliar. One of the younger doctors explains to the white doctor “The patient has a sigmoid volvulus that may be ischemic causing a systemic inflammatory response syndrome manifested by an elevated WBC with bandemia, tachycardia, and peritonitis. Therefore an urgent laparotomy is needed instead of a rigid sigmoidoscopy.” The doctors carry cell phones and iPads, as well as wear watches and new looking shoes that give evidence of the power of a disposable income.
At the bedside, there is an interaction between you, the powerless patient, and the powerful doctors.
The powerless meet the powerful and the powerless has no choice but to become completely dependent on the decisions made by the powerful. The powerful has the ability to choose. They can choose to show respect for the patient and use their power to help, or they can choose to exploit the vulnerable in a time of weakness and abuse their power for their own gain.
This power gap is not unique to Africa and is evident in the doctor-patient relationship anywhere in the world. Most of the time patients have no knowledge of medicine, medical terms, or treatment options. Since knowledge is power, the patient is at a disadvantage and the power resides in the doctor’s position. In the U.S. we don’t like power gaps so there are things in place to narrow it and empower the patient. The availability of many doctors in the U.S. gives the patient choice, and therefore power. Most doctors complain about the medical legal system, but the ability to sue empowers the patient by giving more motivation to the doctor to provide the correct care and not abuse the patient for their own financial well being. The fear of being sued, although not the only motivating factor for good care, is a significant driver of quality medical care. Few doctors in Kenya have the fear of being sued, and therefore delays in care are common, patients are abandoned, and sham surgeries are a real issue.
The power gap between patient and doctor has been most evident to me during my time in Kenya. The combination of poor uneducated patients and limited access to healthcare makes them extremely vulnerable. Therefore it is up to us to use our powers for good. We are Christ’s hands and feet in this world and should love each patient enough to put our own benefit aside and treat people with compassion. The larger the power gradient, the more responsibility is placed on the powerful party.
In Matthew 5:3-5 we see that God loves the poor, the meek, and the vulnerable. “Blessed are the poor in spirit for theirs is the kingdom of heaven. Blessed are those who mourn for they will be comforted. Blessed are the meek for they will inherit the earth.” Why does God love this class of people? Because they are not self sufficient, they are dependent, and they are powerless. Their situation in life forces them to put their faith in God and not themselves. Their dependency on Him highlights God’s power and not their own. Isn’t this what God wants for our lives? That I may decrease so He may increase? (John 3:30) Why does the Bible say that it is harder for a rich man to enter the kingdom of heaven than for a camel to go through the eye of a needle? (Mark 10:25) The answer is because the rich man has a tendency to be self reliant, independent, and powerful. In fact, since glorifying God is acknowledging His power and submitting to it, the root of sin is that we want to have power, and are seeking to become more powerful. The reason Adam and Eve ate the fruit in the garden was because the serpent promised them, “Your eyes will be opened and you would be like God, knowing good and evil.” (Gen 3:4) Our pursuit of power thus further separates us from God.
Although we might not realize it, the reality is that we as humans have no power compared to God’s infinite supremacy. The power gap is huge, as He is the all powerful one and we humans are powerless. Just like the powerful doctor having a choice to care for or exploit the powerless patient, God has the choice to love us sick humans or do away with us. Thankfully, Romans 5:8 tells us that “God demonstrates his own love for us in this: While we were still sinners, Christ died for us.”
So, we as Christian doctors need to realize the tremendous responsibility we have in caring for our patients. We should never take advantage of vulnerable people in their time of need. And, for those non physicians, you too have responsibility and power in a variety of situations unique to your life and career. When I talk to a mechanic about my car, his knowledge and my ignorance create a power gap that he could take advantage of. When I need something fixed in my house, the carpenter/plumber/electrician could easily skimp on the job for his financial gain. The ball is in his court.
Because God first loved us, even in our powerlessness, we Christians need to demonstrate the love of Christ to others and act in their best interest when the power resides with us.
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