love languages in missions

Hickory Dickory Dock

The Zambian mouse ran up the clock.

The clock struck one

The mouse started running down... but then he stopped to talk to his neighbor for a while and three hours later he reached the bottom without feeling at all late…

Hickory Dickory Dock.

There, I fixed it.

One element of Zambian life that I’ve imperfectly chosen to embrace is that of time. Zam-time is enough to make even the super-relaxed white girl crazy. I mean really. I knew white people were uptight about time but I didn’t realize how clock-centered I am until Zambia beat every last bit of sensible time-orientation out of me. For years I showed up to church at 9:00 because every week, they announced that church would start at 9:00, and every week, I sat there by myself for over an hour until the church secretary (who the week before had said the words, “come at 9:00”) rolled in at 10:30 and asked me why I was there so early. I learned that my pace of “casual stroll” was basically a dead sprint as the people walking with me started wheezing while we walked together. And after a few dozen scheduling debacles, I accepted that when someone said they’d stop by for a minute, that the rest of my afternoon was shot as we would indeed be enjoying that minute for a few hours.

White privilege means that my clock-orientaiton is honored in most parts of the world but in rural Zambia I simply unclench my fists and accept a more fluid concept, which is, in many ways, a true gift. 

This gift of time has come into focus for me in the past several months as I feel like I have less of it now than ever before while also finding myself busied with some of the most time-consuming activities possible.

I don’t know exactly how it started, but for quite some time, I’ve basically been running a burn and wound clinic out of my house. We’ve long known that the clinic doesn’t really do burns or wound care. They will tend to you once, swabbing you down with bleach and wrapping you with gauze but Lord help you if that wound needs more than a day to heal because “once and done” is all you’re getting at the rural health center.

Some time back, a patient came to me with a massive wound that was getting no better and after begging for help, I agreed to care for it. This particular woman’s story found its way into village twitter and it became known that I possessed ointments and bandages and skills that actually prevented scaring and gave people their bodies back. The clinic knows this and lets me be, accepting that they can’t complain about my lack of official licensure when they aren’t willing to take over for me. And the patients keep coming. Recently, it has felt like as soon as one person gets better, someone else is wounded and we’re just blowing through sterile gauze and antiseptic ointment and literally hours of my day – every day – are now gone.

honest emotions as I wished for everyone to stop getting hurt

With a school to run, funds to raise, my own children to tend to... I still feel guilty saying that I don’t have hours to spend on this task; I hate that: that by virtue of my clock-centered complaining I somehow make light of what some of these people are enduring. By and large, these are not minor boo boos that need a band aid and a prayer. The majority of people who end up at my front door are there because they need intensive care and the government medical system has utterly failed them. If they were in a first-world country, many would be in burn units and ICUs. My house is, for at least some of them, a last stop before amputation.

its not pretty underneath

I have had to excuse myself from tending to a patient so that I can go and sob on Jeremy’s shoulder over the injustice and the medical malpractice that makes our front room better than the hospital. This should not be, and yet, sometimes it is. The time that this particular outreach takes up feels like it should be of no consideration to me, and yet, with everything else on my plate, it is.

The pain and the injustice and the guilt take their toll and so it meant something that at a particularly low point, a mom of a boy I had treated came back to me to say, J has been asking about you. He told me, “Mommy, Bethany really loves me.” This is the boy that screamed bloody murder every day for six weeks while the burns on his arm healed at a snails pace. He can now hold a pencil, and the grace in his words healed something in me.

this boy - he has spent more than his fair share of sick time with me, but the smile is how I know he's better.

Later, the mother of a child that scowled at me and pushed my hands away as I wiped weeks of dirt out of the filleted skin on his foot came back and said, “Every time we walk past your house, C looks up and smiles and when I ask him why he’s smiling he just says, that lady who loves me lives there.” And as if two rounds of Hallmark quality lovey comments weren’t enough, God gave me the gift of a third and then a fourth who said that word LOVE and I wondered if there wasn’t something to this.

The adults are less cheesy, but I’ve seen a similar affect. When the bandage changes are done and they want to sit and talk a while. When our kids start calling them grandma and missing them when they aren’t there. Every visit hurts, physically, but there’s a deeper healing at work too and all present can sense it.

daily snuggles with grandma, before and after dressing changes are good for both of them.

Despite the fact that I continue to pray through every bandaging and treatment session, “Lord, heal them quickly – for their sake and mine” the un-asked for bi-product of the daily care and the daily concern is that it communicates love in ways that a once-and-done couldn’t have.

to make you feel extra cared for, the babies will put bandaids on your perfectly healthy skin too. 

I’ve spent the last 12 years trying my best to love people. That’s our mission statement in a nutshell. And if I really assess our work properly, our best programs and projects are the ones that afford us the opportunity to spend concerted amounts of time with people. When an area of our work puts us in front of the same people day after day, there is a love language being spoken and clearly heard.

Twenty six years ago, Gary Chapman taught us all that there are different love languages and that if you really want someone to feel loved, you have to speak their language. After the six hundredth super-long chat around someone’s fire or even just standing in the bush path, Jeremy and I started joking that it felt like all Zambians possessed the love language “quality time.” And after logging hundreds more hours spending time with people in the burn and wound arena, I’d say that yeah, it probably is. There is nothing efficient about loving someone through the time it takes for a third degree burn over ten percent of the body to heal, but in terms of communicating love, the relational investment trumps my productivity every single day.

waiting for pain meds to kick in with the distraction of America's Got Talent
(we've watched all of the Zambian gospel YouTube videos already.)

The western world historically has “loved” poorer, third world nations with money. It’s fast, its easy, and above all, super efficient. Even amongst overseas workers, there still exists a mentality of “present the gospel, move on” or in development-worker speak, “dump and run.” We make up for in material gifts what we aren’t willing to give in time. And suddenly, the mission field sounds really noisy.

First Corinthains 13 says that if you don’t have love, you are a noisy gong or a clanging cymbal. I think that if we, the west, take an honest look at our programmatic efforts, even those that try to be gospel centric, we’d have to admit that the love language of the recipient has not been considered.

If spending quality time with people is the greatest act of love in this context, then I wonder if 1 Corinthians 13 could stand an update:

If I speak an African tribal language, but am too busy to love with my time, I am a clanging cymbal.

If I plant churches and build schools at all over but am too busy to love with my time, I am nothing.

If I sacrifice my American comforts and move my family to the bush but am too busy to love with my time, then I gain nothing.

Love is patient with those who want to be with us; 

love does not boast of how busy she is;

it is not arrogant or rude in needing to do “more important” things;

it does not insist on getting back to work;

it is not irritable when things take too long or resentful of lost hours;

it does not make light of the hospitals shortcomings, but rejoices in best-practices; 

love bears tears and the blood;

believes that God is good;

hopes that healing will come;

endures the pain when it all takes time.

Love never ends. As for development, it’ll fall apart; as for workshops, they will cease; as for sermons they will pass away. … So now faith, hope and love abide, but the great of these is love through time.

I still struggle with feeling inadequate – not accomplishing what I need to and feeling like I’m coming up short in every area. And I still hate that so much of my time is going to medical care that isn’t my field of expertise nor really – in the grand scheme of things – my responsibility. But for every person, to step into that space, and allow me to place hands on tender spots for weeks on end in order to see them heal and enjoy their body again  – the process that takes so much care and so much time – if that is what it means to love, then bless it.

where there is no burn unit

I already don’t like this post, and I haven’t even started writing it. It goes against my blogger ethics to share personal stories like this with a broad and unknown internet audience, but I’d like to say that I have obtained permission from each person featured in this post. My friends pictured here want your help. I want your help. We both want the first world to know the rural third world reality.

Please read, and feel, and respond. I’m praying for a flood of advice from real live Peds and PTs, ER nurses and good Samaritans.

~~~

I started to post more info about this on facebook and realized that I do not have the space (or patience of thumb typing) to make this happen.

Let me start with the background info: a story of three burn victims.

Michael’s foot and leg were burnt by boiling water that tipped from the fire. His mother took him from the clinic and they kept him over night for observation. They gave him acetaminophen and washed the wound with bleach water. Before sending him home the next day, they drugged him up with sleeping pills so that he wouldn’t be too active and get the wound dirty. After a time, the wound got infected. He had been discharged from the clinic a few days prior with no instructions, and so his mother turned to traditional medicine. She put toothpaste and ashes on the wound and left it. The infection got worse and Michael’s pain increased. I asked if I could wash the wound each day, which the family was glad for and it eventually cleaned out and healed.  The skin around the ankle grew back tight and he has thick scaring at the site, but is otherwise fine.

Kalunga tripped into a pot of boiling water and burnt his leg from hip to toe. His mother also took him to the clinic where they also gave him acetaminophen and washed the wound with bleach water.  After being discharged, his mother took him to the clinic for regular cleansings with bleach water during which Kalunga screamed so badly at the pain, breaking his parents’ hearts. They could not stand watching the clinical cleaning procedure. They kept him at home and used ash to pack the wound and after a time it got severely infected. I offered to help him clean the wound and kept Neosporin on the area, re-bandaging his leg twice a day for two weeks. His skin did heal, though the area around the knee has limited range of motion and he limps a bit when running.

Bana Miri lost consciousness and fell into an open fire. No one knows how long her arms were laying in the fire, but her flesh was incinerated to the point that we could see bone. She was referred directly to the hospital where they gave her acetaminophen and washed her wounds with bleach water. After a few days, she was discharged. The family cared for the wounds with toothpaste and ashes. After a few weeks, the family called me because her wounds were so rancid that anyone who walked into the house commented on the rotting fish smell. I took her straight back to the hospital where they continued to soak her hands and arms in bleach water. After a few more weeks of negative progress, they transferred her to a hospital in Kitwe where the doctors started talking amputation. The family pleaded that she be able keep her hands, so after getting the infection under control, the hospital sent her home. Bana Miri no longer has any functional use of her hands.

Do you hear the commonality in each story? Tylenol, bleach, end of clinical care, ashes and toothpaste, infection, and permanent damage.

When Bronwyn was burnt in similar manner a few weeks ago, many people urged me to take her to the hospital. I hope you can appreciate now why I opted not to. If Tylenol and bleach were the solution, I could have done that myself. Thankfully the water that fell on her was not fully boiling and her skin never burst and nothing got infected. We are thanking God for this mercy.

But the prompting of this post comes from a more recent story.  Please keep reading.

Four days ago, Patience’s sister dropped a pot of boiling oil and the oil splashed across Patience’s legs. Her mother was not home, but the neighbor lady immediately covered the burned area with toothpaste and stared walking with her to the clinic. At the clinic, the nurses scraped the toothpaste off and kept the wound clean with bleach water. One tube of Silver Sulfadiazine was in the cabinet (and no one knows where it came from, so I’m calling that a miracle) which they put on the child’s knees until the tube ran out and they sent her home. (Note that Silver Sulfadiazine did not exist in Mansa at the time of the first three burn cases, which is why there is no mention if it in their stories.) Now at home, her mother is too afraid to hurt her child, and she has asked me to be the home aid nurse, which I am certainly not.

Naturally, I am terrified. I am terrified that her knees will not heal properly, that she will not be able to bend them. I am terrified that she will be in unnecessary pain. I am terrified that I do not know what I am doing. As I asked for help on facebook, many responded that I should take her to the hospital. I hope that the above stories shed some light on that option. The one difference in Patience’s story is that I now know about and have access to Silvadene. A newer pharmacy in Mansa now carries it and, after Bronwyn’s burn, I stockpiled. (It’s a shame that I am willing to buy this medicine, but the Ministry of Health is not. But that is a post for another day.)

Please know that all of these people are dear to us. Michael is named after my husband. Kalunga has the most contagious laugh and has been on my top-five-people-on-the-planet list for a long time. Bana Miri is the wife of one our former staff members (he stopped working with us to care for his wife full time) and she is the BEST. Patience is one of Bronwyn’s friends – they have played together since birth. These people are important to us – they are not just names or pictures or case studies.

But I am not a medical professional and other questions remain. Questions about the sloughing that the clinic seems obsessed with – scraping back the clean-but-dead tissue until her knees bleed. Questions about their wrapping technique. Questions about the Silvadene application. I don’t want this little girl to end up like the others. I cannot distance myself emotionally from this situation either. Her cries are fierce and I’ve wept for her pain. I look at her laying miserable and imagine Bronwyn and I can’t not commit to her healing.

There are complicated sub-stories woven tightly into each of these burn scenes. Stories of poverty and the daily hazard of cooking on fires. Stories of inadequate health care and sub-par patient education. Stories of apathy in resource sparse locations. Stories of traditional medicine and witch doctors and mothers that would do anything – try anything – to make their babies feel a little better.

And these are stories that also need to be told and hopefully will be told at some point. But right now the clock is ticking and I have one hour, thirty three minutes until I am due to arrive at Patience’s house to “help” her mother and my cheeks are tear stained and my hands are trembling.

This is me reaching out. Who will skype facetime with me from inside Patience’s house? Who will look at pictures and advise wisely? I have access to google and I am using it. I’m looking for specialized advice for individualized care, not because I think webMD is wrong but because I can’t stand being involved in another burn victim story without reassurance of a qualified, live person telling me that this is the best anyone could do.

Please.

And thank you.