1 Nov 2023

I stood up from the stool in the ultrasound room and faced the family. The surgeon didn’t really need the ultrasound to confirm what we already knew—this tumor was too advanced. For two years this man had sought care in other hospitals and health centers intermittently, then he had heard about Béré. In the meantime the tumor on his left anterior hip had continued to grow. The mass clung firmly to the structures around it. There was no way the surgeon was going to operate. It wouldn’t help him. Do no harm. How to convince them that we care and we want to do everything we can to help and also convince them that surgery would only harm him? The patient’s father slowly started to understand that we weren’t going to operate. The patient’s young son played on the floor near the ultrasound table. "But we have been to other places and he just kept getting worse and then we heard that in Béré there’s a guarantee!" I let out a small exasperated laugh, "A guarantee? What is the guarantee?" "A guarantee of receiving normal care here!" Part of me wanted to cry. The family was so desperate for a morsel of hope. Normal care. What a low bar to set! Such a low bar, and yet too often we’re so far from it. But the truth is, so many of his options have made the care we’re able to provide here seem like quite a close approximation of "normal." The "standard of care" is a far off dream in our treatment of so many of the conditions that present to us. For some patients with certain diseases we can actually offer the standard of care. For others the diagnostic testing or treatment just does not exist in this country or any of the bordering countries and it might take us decades to bring that capability to them. In the meantime, they arrive with so much faith in us. But what else can they do?

Patients like this remind me of Naaman. A wealthy, important person with an untreatable condition heard that in the neighboring country miraculous healing might be possible. He got his king to write a letter of recommendation to the king of that other country. This would make a lot of sense in Chad—showing up with a letter from the highest authority you can find to say this is an important patient, make sure he gets normal care. As Americans sometimes we balk at that. Of course we want to give him normal care, whether he’s an important official or a poor worker in someone else’s rice field. But the king didn’t receive the letter well. He was exasperated by the expectations apparently put on him. "He tore his robes and said, "Am I God? Can I kill and bring back to life? Why does this fellow send someone to me to be cured of his leprosy? See how he is trying to pick a quarrel with me!" (2 Kings 5:7) In the chaos of seeing outpatient consults during dry season—when many patients come from far away hoping to get a different answer from what other hospitals all over the region have offered—I often feel a similar exasperation. I can’t meet these expectations to see the patient who traveled from far away right after he arrives, give him a quick fix that miraculously solves everything and send him on his way the same morning so he can travel all the way back home before evening. Who do you think we are?!

Elisha had a different perspective.

"Why have you torn your robes? Have the man come to me and he will know that there is a prophet in Israel."

Where the king saw a setup for failure, Elisha saw an opportunity for God to reveal himself to Naaman.

He didn’t actually meet Naaman’s expectations. Naaman, in fact, "went off in a rage," offended that the treatment demanded more of him than he had expected should be necessary. But Elisha didn’t worry about Naaman’s rage; he just passed on the message God gave him and trusted God to heal.

Our job isn’t to meet expectations for every patient in the region, and I don’t have to get frustrated or angry when we can’t meet impossible demands. Our job is to be available for God to use us however he chooses in each encounter with patients, families, or officials. We also pray that over time this work brings the reality of the medical care available to our population a little bit closer to "normal care."