Good morning from Ethiopia!!  My time here is rapidly passing by.  I find that just as you start to figure out the paperwork and routines it is time to leave.  I still have a bit over a week, but the end is approaching fast.  Soon I will be out of the very cool highlands of Addis and return to the desert.  I have lived in many different places this past year — Kenya, Michigan, Honduras, Ethiopia, and the United Arab Emirates.  Each place has a special beauty; each place is home to many beautiful people.

The week was a busy one, seeing many patients in clinics and in surgery.  I also received some GREAT news — my license has been issued in UAE!!  This is much sooner than expected.  A business visa followed within a short time, another miracle!  After much waiting, travel, and reams of paper, we are ready to start the adventure of Oasis!  We can officially organize a schedule and start to see what awaits this new service.

As I was thinking about the note last week, my mind  kept drifting to and fro about the topic of short term missions.  Short term mission work is often a topic raised among mission agencies, NGOs, and long term missionaries.   I don’t think there is a clear cut answer as to the value of short term visitors to the long term work of the mission or NGO.  People, of course, have firm opinions one way or another.  Some people boisterously voice the opinion that the only way short termers can help is if they are asked to give donations in addition to the cost of the trip.  Others say rather than going, the groups should donate the cash.  These perceptions may be theoretically good options and opinions but assume the money is there to give without people driving a vision and obtaining the gifts.  Likewise, you assume the trip is all about ‘your’ work and no other plan is at work in the lives of the participants.  These can be dangerous assumptions.  Other people talk of the value visitors bring and welcome more to come.   I of course have an opinion as a long term missionary as well.

Short term volunteers fall into many categories and cannot be lumped together.  Apples, oranges, and mangoes are all fruit, but each has its particular flavor and characteristics.  Short term volunteers don’t necessarily have to travel far; you can do so within your own community.  I thought today I would give my thoughts about short term volunteers coming to a medical/spiritual ministry such as CURE.  In the Mead family we consider this ‘free advice.’  The rest of the saying goes that “Free advice is probably worth what you pay for it.”  You may or may not agree with my perceptions and thoughts, and that is OK.  I hope at the least a few discussions take place as we explore this area of service.

As I was contemplating this topic of short term volunteers, I came to divide volunteers into four different categories.  We will not discuss what is meant by ‘short term’ — a week, a month, a year, two years?  Length of service is a whole other topic.  Today we discuss the different ‘fruits’ serving far from their community in a setting like a CURE hospital for shorter times, say a couple weeks up to several months.

The first category is the “All about Me” volunteer.  This person looks to volunteer for the excitement, experience, or a line to add to a CV.  I hear about the “great hope” coming to save the poor people of a distant land — all, of course, within a couple weeks.  These individuals envision themselves as deserving bows and heart felt thanks upon arrival from all the staff and especially love being waited upon.  Often they have other agendas outside of the hospital and expect us to drop all and take care of these needs.  What do you mean you can’t drive me into town to shop?  You have a job?  As surgeons they commonly arrived to teach the local guys the ‘correct way’ to care for the people.  Often they are shocked at the deformities we see.  Some surgeons come to realize a second year orthopedic resident has more experience, knowledge, and wisdom in the care of many deformities than they.  Some volunteers just throw their hands up and withdraw.  Some will ignore the experience the local surgeons have and show us a ‘better way.’ After all, they never have to see the child again, and it may work.  I have seen surgeons declare the hospital ‘hopeless’ and leave soon after arriving (thankfully, not at a CURE facility).  Often, the unspoken goal of the trip is to get weird pictures and stories to share around drinks with their friends.  “Just look how great I am.”  This group is very disruptive; they would be best to stay home.  Thankfully, we don’t see too many of these volunteers.

Group two is the people coming to help in any way possible.  They come with useful skills but really don’t know exactly what they will do.  The key attribute of these volunteers is flexible servanthood.  These people find out that no matter what their thoughts and plans, God often has a different plan for this time.  People arrive seeking to serve and discover their eyes and hearts are opened to a whole new world.  As they seek to learn and interact with the staff, they appreciate new ways of doing things, see how others live, realize how materially blessed they are, and envision needs they did not know existed.  I entered Kijabe really within this group.  My family came to Kenya for our “once in a lifetime, never to be repeated trip to Africa.”  I had some surgical capabilities and was willing to learn and help in any way.  I planned never to return to Africa, but God had other plans.

I have attended conferences where they polled the audience of long term volunteers.  The question was, “How many started out as short term missionaries?”  The overwhelming majority did so.  Of course, not everyone will risk becoming a long term missionary by coming overseas for a short visit, but few return unchanged.   How that change may manifest is not uniform.  A small minority will support the work of the place they visited. Great!  Others will see a new calling to something entirely different.   Great!  Others may just have a different appreciation for what it is to work outside of your culture. Great! Some may decide to step out within their own community to serve. Great!  Others may ‘adopt’ a third culture kid attending college close by to them but far from the student’s parents.  Holiday breaks can be long and tough if you are alone. Super great!  Although these volunteers do not really make dramatic long term changes to the work locally, I strongly support their coming; we are able to become a platform for a life changing experience.  After all, the work is not MY work but God’s work; I just get to tag along.

Group three individuals are the closest to my heart.  This group encompasses a diversity of gifts and skills but is sold out to build and assist the work being done.  The group is often characterized by multiple trips and/or support from the US.  These volunteers provide assistance within three broad areas:  emotional support, equipment and supplies, and educational assistance.

I have friends who epitomize the emotional support.  They have come many times to Kenya.  They do whatever is needed.  Bev and Mel have painted walls, re-covered a couch, listened, babysat for other missionaries so the parents could get some time away, worked in a variety of jobs on the station, cooked meals, listened, sorted through cupboards and boxes, performed hospital inventory, listened, and more.  One other man came as “Mr. Fix-it.”  He went from the different homes fixing the old appliances, plumbing, broken shelves and cupboards — whatever was needed.   Last summer, groups arrived to repair and improve CURE staff housing.  Leaky pipes were finally fixed.  Broken cabinets were replaced.  Tile floors made bathrooms gorgeous.  The smiles were huge!   Since much of what we have is rather dated, the assistance was fabulous.  Speakers have come to teach and uplift those serving.  Chocolate chips made special cookies –  just like ‘home.’   This support can really make the difference as you push on.

Equipment and supplies are always in short supply.  We have people seek out donations, buy items using their own funds, and share the hospital needs with others.  These activities are way out of character and beyond their comfort zone for sure, but they do it because they know there are huge needs and to them the work is important.  So much is thrown away in the developed world that would be valuable in the developing world.  Now hold on.  Before you run out and start sending everything you find, let me tell you: all materials not being used in the US are not necessarily valuable for use.  We receive many items that are shipped at great cost only to be worthless at the hospital.  I could have fun telling you some of the things shipped over the years to a pediatric orthopedic hospital.  Say for example, you have all the suction tubing for a special irrigating system and know we could use it.  Send it!?!?  Maybe, maybe not.  IF we have the right machine and it is the right model that fits the tubing then OK, maybe.  If not, it is merely junk we need to figure out how to dispose of safely.  Likewise the governments have rules about expiration dates.  Maybe you and I think the item is still good, but the government may stop a whole container at the coast if there are outdated medications and/or supplies.  Fines can be levied.  As they now search through the whole container, storage fees build up quickly.  Rather, maybe you could ask what is needed before you go or send.  Tell them what you may be able to get and ask if it would be good.  A group asked how to help; we went online and found reusable cloth operating room gowns which are extremely necessary and hard to find in-country.  The group purchased the gowns and the hospital now can perform surgery with improved safety.  I know a men’s group who wanted a manly project.  They raised the funds, purchased, and shipped a front loader heavy equipment vehicle for the station.  Tim Taylor would be thrilled!!  Sponsoring the cost of obtaining and shipping a container full of supplies would be grand.  Many good options exist for creative people wanting to help.

Teaching and educational materials work at two levels.  On one level experts can teach and share techniques capable of being reproduced with the country.  Attending and resident surgeons can learn new skills.  Dr. Louis Carter, a plastic-hand surgeon, has come yearly to teach at Kijabe and many other sites.  I learned much about burn contractures, flaps, and congenital hand conditions from this man.  Nurses, pastors, therapists, orthopedic technicians, business office personnel, surgical scrubs, maintenance workers — all can learn from quality teachers.  Repeat visitors know the systems and can jump in faster.  Appropriate lectures can be planned ahead of time.  Growth will occur over the years as the complexity and quality of care grows.  The second level is through supplying books and other educational materials.  Libraries in the developing world are notoriously limited.  DVDs have compressed books into manageable size parcels.  Some of us ‘old guys’ still like to feel of a book in our hands.  Texts that may not be the most recent may actually be better for the needs of the developing world.  After checking the book’s value to us (medical, spiritual, nursing, therapy, orthopedic technology, computers, software, etc.) the books or discs can be carried by visitors or placed in containers later arriving at CURE facilities.  Again, not all are valuable, so check with someone at the hospital you are supporting or at CURE headquarters.

These volunteers are within the core of the ministry.  They are the volunteers to seek out.  We welcome news of their return.

The final group is often what falls into my exception group.  These are not mainline vision visitors, but they represent the only hope for a group of patients.  These specialists can organize to perform care not available in the country.  For example, last week a group of very talented maxillofacial specialists arrived to care for people with huge jaw tumors.  Nowhere in Ethiopia can these tumors be treated successfully.  Prior to the team’s arrival, CAT scan reconstructions of the jaws were inputted into special computer programs  to visualize the tumors in 3-D and plan the resection.  Guides were created to identify the exact cuts on the fibula leg bone to create a new jaw.  Custom titanium plates were created, purchased, and brought to serve as the infrastructure for the new jaw.  Special instruments, suture, and of course talented surgeons created a functional, high-tech team.  A micro-vascular surgeon harvested the long segment of bone from the leg with a skin segment and its vascular lease.  After the tumor dissection was done and the tumor removed, the fibula was cut using the guide.  The micro surgeon carefully married the tiny fibular vessels to small recipient vessels in the face/neck.  The plate and fibula were anchored to the remaining structures and they finished.  The surgeries started early and went late.  Five major tumor resections were done in the week.  These patients were thrilled.

These cases need to be the conscious exception rather than the rule for the developing world.  You could never do enough of these cases to fulfill the needs present.  The cost in time, money, and resources is not manageable on a bigger scale.  In fact, without the support of companies, these cases would never happen.  But you can help some people.  The key is not to hurt your vision work but still have compassion on those in need.  If doing these few high-tech cases takes away funds for your work, then you need to consider in the real world of very limited funds if these cases are the best use of the resources. Are you denying many others care so a few can be treated?  A tough question that is easy from afar but difficult as you face people up close.   As long as you enter with your eyes open and you feel comfortable caring for possible complications, then you may cautiously proceed.  As I said, for me group four is the exception and rarely possible.

So we have our groups of four.  The first is “all about me.”  The second comes but God changes their plans.  The third jumps in with both feet and becomes a supporter.  The fourth comes to bring hope to a few.  A fifth group of volunteers does exist.  This group is the one who sits at home saying, “Someone needs to do something!”  Instead of being that someone, they remain comfortably seated.  What they don’t know is that right outside their comfort lays a whole new world where joy is found in serving.  There will be trials.  You will often feel uncomfortable.  Your focus will slowly shift from me and mine to the needs of others.  Life will become an adventure as you step out and live in His grip.

One of my favorite quotes:

It is not the critic who counts; not the man who points out how the strong man stumbled, or where the doer of deeds could have done better.  The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood: who strives valiantly; who errs and comes up short again and again; who knows the great enthusiasms, the great devotions and spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement; and who at the worst if he fails, at least fails while doing greatly; so that his place shall never be with those cold and timid souls who know neither victory or defeat.   — Theodore Roosevelt