Bringing the Art of Nursing to La Carpio, Costa Rica

As you may know, I had the opportunity and privilege this past spring break to serve the people of La Carpio through International Service Learning, as a part of Shorter University School of Nursing‘s Global & Community Health Practicum. Even having been on several international mission trips before, this experience changed the way I perceive poverty, healthcare, and my role as a nurse.

During the first day of clinics, we went door-to-door, surveying the population and giving appointment cards to those with acute illnesses that needed our care. This served multiple purposes. Primarily, it ensured that the patients that came to our clinics were in need of treatment and could be served by the resources we had on hand. We didn’t have the means to treat every condition, so by seeking out people that we could help the most, we avoided making promises of care that we couldn’t keep. Secondly, it served as a venue to provide therapeutic communication to even those who we could not treat. We spent the same amount of time with families that we could treat as we did with those that were beyond our scope of care.

That is not to say that choosing which patients to give appointments to came without a challenge. At first, that responsibility brought some intense anxiety. We were split into small teams and given complete independence in deciding who to give appointments to. I started to ask myself how I could be sure that I made the right decisions. I had to reconcile with my faith leaving a family’s house without having given an appointment to anyone. It became good practice in faith and trust. First, we had to trust in God’s guidance and sovereignty. Relying on the Holy Spirit took a lot of weight off of our shoulders and helped us realize that all we had to do was be obedient in His direction and trust Him to care for those that we were unable to. It also provided a great opportunity to trust the nursing judgement of ourselves and each other, which we will carry with us into our practice as future nurses.

We soon felt confident in the interviewing process, but the poverty we faced that day was impossible to ignore. Even though we prepared ourselves, what we saw changed us.

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(Photo credit: Travis Lugo, BSN Student)

Poverty plagues La Carpio unlike any city I’ve visited before, domestic or abroad. Two out of three residents ended up being Nicaraguan refugees. Some were there legally, but many didn’t have documentation, and therefor had little to no access to health care. The people who did have access to running water said that it was unreliable and sometimes unclean. Many of the adults had little to no education and therefor limited employment opportunities, if that. Their homes were built with whatever materials they could find, on steep, hilly terrain, and in the flood zone of a nearby river.

Yet, their joy and gratitude for what they had was often written all over their faces. They didn’t need us to feel sorry for them or give them “a better life.” They genuinely loved their life, and just needed our time and our genuine, loving care. Charity is something they could use, for sure, especially with regards to cleaner water, but that wasn’t the role God gave us there. We were there to give them holistic, patient-centered nursing care. We had to set aside our desires to provide them with every little thing we thought they needed, and accept the work God laid out for us. Through Him, we were making a difference despite their living situations remaining the same. The healthcare system only lets local doctors spend up to 10 minutes at a time with patients, and many doctors work without nurses. Taking the time to interview them and spending an hour evaluating them brought them more joy than we can know.

I had to continuously remind myself that I was making an impact on both their physical and spiritual health, despite not being part of my idea of a typical medical mission trip. At first it was a major struggle, because I didn’t get to spend hardly any time at all praying with patients or guiding their spiritual growth. During my service in Mexico, we prayed with every single patient, but in Costa Rica the focus was more on their concerns and well-being. While in Mexico, I saw up to a hundred patients a day, ISL’s program makes appointments with about 50 people, spread across three days and two clinic sites.

It was a contrast, for sure, with what I was secretly expecting, but perhaps not a bad contrast. I think both approaches could maybe learn from the other, but I grew an appreciation for ISL as the week progressed, because of the vast amount of time I was able to spend with each patient. I discovered issues my patients were dealing with that I would not have had time for in a fast-paced, high-volume clinic. Our thorough conversations were able to identify a patient whose history of sexual child abuse accounted for most of the presenting physical symptoms and a patient whose chief complaint turned out to be less serious than an existing condition that he had no idea about.

Even when the patient’s history had little to do with their presenting symptoms, the fact that we were interested in knowing about them brought them joy. They were excited to share their life and health with us. Their spirits were lifted by the amount of time being invested in them. We assured them with smiling faces that they were going to be taken care of today, and that is spiritual care. Even if I didn’t break open a Bible.

A healthcare role unique to the nurse is the opportunity (and responsibility, really) to strengthen a patient’s spirit. False hope does no good for a person, and I would never advocate that, but instilling genuine joy and a healthy hope for their future well-being works miracles. A nurse can make a patient feel like someone really cares about them and is willing to go beyond treating physical symptoms.

Although my father’s cancer diagnosis was absolutely terminal the day he found out (and deep down, we all knew it), his nurses kept his spirit up the whole time. When the doctors told us he wouldn’t make it past the weekend, he made it another month. And another month. Not because the nurses gave him the false hope that he would pull through, but they treated him like a real person. One asked him about his family and watched as his face lit up while he talked about us and showed pictures. Another used appropriate humor to get laughs out him. He not only got the best treatment available, but he was confident in the care he was receiving. The combined efforts of the doctors and nurses at Northside helped him believe he was in good hands. His body was actively destroying itself, but his spirit endured.

Solomon, one of the few men to ever be gifted by God with complete wisdom, said this about the importance of joy and spiritual care:

A joyful heart is good medicine, but a crushed spirit dries up the bones.
– Proverbs 17:22

We call this the art of nursing, and it can’t be taught by reading a book or listening to a lecture.

I chose Shorter University’s School of Nursing because of the commitment to integrating faith and profession. Our trip to Costa Rica confirmed I made the right decision. Seeing and caring for the people of La Carpio gave us a new compassion for our patients and a greater passion for our field of work.  We practiced nursing care through assessment and administering medication, but also the art of nursing through therapeutic communication and counseling. The local doctors working with ISL showed genuine interest and even eagerness in teaching us about what we encountered, and encouraged us in our own careers. Our translators, many of which were med students, proved to be a tremendous and irreplaceable aid to our work. All-in-all, it was incredible.

If I’m being honest, I went into this trip unsure of the impact I would make, but I have come out unable to ask for a better or more fruitful experience. If I ever came across another chance to work with ISL, I would definitely take it in a heartbeat!

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“Heal the sick who are there and tell them, ‘The Kingdom of God has come near to you'” – Luke 10:9

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Good Mourning

Few people know this about me, but I love to listen to rap while I’m on the road. Andy Mineo, Lecrae, and Trip Lee take turns riding shotgun during my short daily commutes to school, work, and home. The other day, Andy Mineo’s “You Will” started playing on my Spotify, and tears started rolling down my face. Immediately, my thoughts went something like “What is wrong with me? This is rap. This is upbeat. Why can’t I hold it together? I’m crying over nothing.”

I must have played that song on repeat a dozen times during the eight months my father received cancer treatment, and I owned every line of the lyrics. I believed my father could be healed, and I believed that my Father in Heaven would if His will allowed it and my faith was strong enough. The song hit home, and it hit home hard.

It became evident to me at that moment how much I have been neglecting my journey through grieving my father’s death.

I have a difficult time allowing myself to grieve. Not only do I not allow myself to grieve, but if I’m being honest with myself, most days I just don’t want to. I don’t want to face the fact that he’s gone and I’ll never share another memory with him. I don’t want to face the fact that he spent his life believing that I would be great and make a difference, but won’t be able to see me live that out. I don’t want to face the fact that my children won’t know him.

It’ll be two years next Thursday, March 3rd. In the nearly two years that my father has been dead, I have filled nearly every moment of my time with stuff so I wouldn’t have to think about him.

I think I’m protecting myself from hurt, but I’m really not. I’m hurting whether I like to admit it or not. If I don’t confront my hurt, it’ll eventually come out whether I like it or not.

Like while I’m jamming to Andy Mineo in the car.

Or while I’m pulling shots of espresso and it’s so evidently written on my face that my co-worker and dear friend pulls me aside and asks if I’m okay. Or when I zone out during a lecture at school and the professor assumes he’s said something that really worried me. Or in the hospital room when I obsessively check a patient’s oxygen saturation because I spent the last 48 hours of my father’s life looking at his fluctuate until he passed away.

It’s the elephant in the room. The spirit always remembers, even if the mind tries to forget.

I’m kidding myself by thinking I can just fake it until I make it. I can’t. None of us can. It’s a lie. When we’re not okay, we’re just not okay, and that’s okay.

Because what am I really doing to myself when I refuse to grieve? I’m robbing myself of joy and I’m robbing God of His glory.

When I’m so caught up in not wanting to face never creating new memories with my dad, I rob myself of the joy I shared with him while he was alive. I should be intentionally remembering him and enjoying all those moments. There is healing in that.

When I’m so caught up in thinking about how my dad isn’t around to see me get through nursing school and become the healthcare professional he believed I could be, I rob myself of feeling good and proud about myself. It should be enough to me that my wife is proud and God is proud. It should be enough that my dad would be proud. I can’t be afraid of graduation just because he won’t be there. I can’t just refuse to walk that day. I have to confront this head-on before I let it rob me of all the good that God intended for me to enjoy.

God intended for us to lean on him while we mourn. He promises to be there. Neglecting my journey through grief is robbing myself of His comfort, and robbing Him of the glory that will come through my faith. Jesus says it plainly:

“Blessed are the poor in spirit, for theirs is the kingdom of heaven.
Blessed are those who mourn, for they shall be comforted.”
– Jesus Christ, from His sermon on the mount (Matthew 5:3,4)

By avoiding the issue, I’m not giving God an opportunity to comfort me. I’m not claiming my inheritance – the Kingdom of Heaven. Who am I to turn away the Creator? Especially when He intends to do good to me? I’m undermining the healing power of the Gospel. I’m denying others around me and the kingdom of God the testimony of a Christian mourner. I’m like Rachel, who turned away her comforters because she felt as though her loss was inconsolable (Jeremiah 31:15).

But it is not. No loss is inconsolable.

“He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away.”
– John (Revelation 21:4)

In His revelation to John, Jesus offers us complete healing, comfort, and joy in the life to come, despite all the sin we may have let ourselves fall into. He not only forgives, but offers us the most precious gift – Himself for eternity in paradise.

How can I appreciate this amazing grace and gift to come if I don’t acknowledge it when I’m going through something that – for lack of a better word – just plain sucks? I can’t claim a promise if I don’t realize that I need it.

I mentioned in my post entitled 2015 that though I failed to last year, I want to be more intentional about confronting my journey through grief and share my experience with those around me.

This isn’t me asking for attention or sympathy at all.

This is me, laying it all on the table.

Maybe you’ve been through a loss, too. This is me saying to you that you’re not alone. It’s okay not to be okay. We’ll get through this together, and it will be good.

As in all things, there is good in mourning.

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“Lord, there’s nothing you can’t do, / [There’s] nothing in this world too big for you. / So when they say you can’t, / I know you will. / I know you will.” – Andy Mineo

True Joy (Tales of a Nicaraguan Missionary Journey: Part 2)

Earlier, I attempted to share my experience as a missionary in Nicaragua, only to discover how very much there is to share! I only got far enough to tell of how God got Kaitlin and I to Nicaragua, I didn’t even begin to tell of our time actually spent there. If you haven’t already read it and are interested in how God provided for our journey to Nicaragua despite great difficulties, check out my previous post.

On June 9th (2013), Kaitlin and I, along with our team members, boarded a Delta flight to Managua, Nicaragua. Before I dive any further, it’s important to know a little background information about Nicaragua and its people. Nicaragua suffers from terrible poverty, with over half of the population unemployed or underemployed, and a fourth of the country without safe drinking water. A quarter of a million children in Nicaragua are illegally employed to supplement the bare survival income of their families, and a third of all children suffer some degree of chronic malnutrition. The poor have little to no access to health care, and child mortality rates are six times worse than the United States.
Our time in Nicaragua was the first in which we had ever witnessed extreme poverty first-hand. Facing that degree of poverty was hard, but also different from what we expected. Most of the people we met with (especially those who already knew the LORD) were joyous, happy people. They may have had lives that were much simpler than ours, lacking the resources we take for granted, but they appreciated what they had and didn’t let anything affect their joy. They were normal people, just like you and I. They didn’t seem to want to be pitied or bombarded with aide. They just wanted to get to know us and let us build a relationship with their community. It didn’t take long at all for God to start teaching re-teaching me another lesson or two…
True joy doesn’t come from stuff, it only comes from Jesus. 
Alternatively, We don’t need stuff, we only need Jesus.
 
Perhaps the perfect example of this that we witnessed was an elderly woman named Santita. She was very sick the day that we met her, but still full of the joy of God. She asked us if we would let her sing to us! Of course, we said we would love that. After praying for her singing to glorify the Lord, she blessed us a song, which I was able to get a clip of:



Her love of the Lord is so evident, and we were so grateful to have met her. Despite living in poverty and facing sickness so great that she felt as though she would not live very much longer, she had reasons to sing to the Lord. Her last words in the song were prayers of “Glory to God,” and “Praise the Lord.” We were all so encouraged by her faith and love for God, and I pray that if Kaitlin and I get the chance to return next year, we will have the opportunity to visit her again. Will you join me in prayer for her? Please pray for her health, and that she would be a light in her community. Pray for her village to come closer to the Lord and be protected from illness and the Enemy.Santita was not the only one. The villages were full of wonderful people that we fell in love with. They lived simple lives, but were okay with it. I’m not talking about neglecting essential needs. These people need clean water and adequate food, and we did take time during the week to hand those essentials out and meet their needs. The book of James is clear on faith being dead without works, and that there is no sense in telling people that Jesus loves them if we were not going to love on them through meeting their needs. However, you don’t see sophisticated living structures, big fancy meals, any cars at all, gadgets/gizmos, etc. They live on the bare minimum. Their lives are simple. But, no matter what my idea of “living standards” and “comforts” were, God quickly changed my heart from an attitude that thought my purpose was to make their lives “better” to one that knew that all they really need is Jesus.

Am I making any sense? I almost felt a little envious of how simply they lived. I get so used to the noise and busyness of the United States, that being in a place away from it all was quite refreshing. I was able to feel God’s spirit so much better. I was able to sleep sounder and wake up with much more energy. My spirit desperately needed that break from the noise, and I am so grateful for it.

I think we have gotten too used to welfare culture, and it seeps into the way we look at missions. If our missions were solely based around taking resources to needy communities and giving stuff out, we would not really doing the people a service. All we would be doing would be setting up a welfare system that the people can become dependent on. Our mission host family even discouraged us from giving stuff away to the children, because none of the families want to feel like we pity them. They want to be treated like normal people. We didn’t neglect their basic needs, but didn’t focus on it the entire week. The focus was sharing the gospel, getting to know them, and praying for them.

There were several instances where the people would even give something of theirs to us, even though they had little. Kaitlin was especially touched by a girl named Kim, who gave her a bow after a church service:

I’m so glad I was able to capture that moment. For the average American, that would be a small gift. Coming from this girl who had so little, though, it was very special.

We live in a culture that holds on to things. We seek more and more things to satisfy our itches and obtain comfort or happiness. A 2010 Princeton study even stated that Americans believe happiness peaks at a salary of $75,0001. Nicaraguans like Santita probably won’t see that kind of money in their entire life, but live life with a joy so complete that none can compare.
Jesus says in John 10:10 that he came so that we “may have life to the fullest.” Other versions use the phrase “live abundantly.” He also says in John 15:10, “I have told you these things so that you can have the same joy I have and so that your joy will be the fullest possible joy.”
Life and joy to the fullest does not come from things or a certain salary, but from Christ alone. I am so glad God chose such an incredible experience to reaffirm this truth in my life.

– Zack

1. Data taken from an article in Time, “Do We Need $75,000 a Year to Be Happy?” – http://www.time.com/time/magazine/article/0,9171,2019628,00.html