In Port-au-Prince, our medical mission team stopped at an orphanage to provide lunch for the children (peanut butter and jelly sandwiches we made the night before), to make donations of clothing, school supplies, and games, to provide basic medical care to those with the greatest need, and to spend some time playing with the children.

Many orphanages in developing countries lack adequate services … running water, electricity, sufficient staffing, and medical care. In addition, the children come from deplorable situations, often carrying physical and emotional scars from their difficult situations. Some children are simply dropped off by family members, because for some reason they feel unable to care for them. Then there are others who are found in the trash. Sometimes, children have had some kind of medical situation that their families were unable to attend to, compounding a situation that may lead to a permanent condition or amputation. The permanent medical condition they created by not being able to access or provide adequate medical care often leads to abandonment. Some children are born on the streets to prostitute mothers and are abandoned or brought into the world of prostitution at an extremely young age until rescued by someone who cares enough to bring the child to an orphanage. Sometimes a mother will move in with a new boyfriend, bringing the child with her, and then use the opportunity to abandon the child at some point in the future hoping the boyfriend will see the child as his responsibility. In some cases, children are left in abandoned homes, or are locked in closets or small rooms for long periods of time, because no one is available to care for them. While the stories seem endless, the reality is that NO child should have to experience any of these life scenarios. And yet, many do … daily.

An orphanage visit definitely emphasizes the point that mission is more often about “being” than “doing.” Orphans need someone who will be with them, staying long enough to let them know they aren’t forgotten … that they are loved. On this hot sunny day we arrived to a very warm and energetic welcome … in fact, it was a bit overwhelming, particularly after four very full days of medical clinics. All of the children were excited to be touched, held, or to be played with. Many signaled that they wanted to be picked up. Once raised into our arms, most didn’t want to be put down nor did they want to let go. Like several others in our group, I quickly ended up sitting on the floor so that I could hold more than one child at a time.

One young boy (~ 4 years old) will be in my thoughts for a long time to come. I never knew his name, and he didn’t say a word to me. He sat on my leg for a long while … just sat. At one point, another child tried to monopolize me and he got very upset. He didn’t say anything, but used his presence to make it clear he wouldn’t be moved. What sticks in my mind about him was that he didn’t seem to have any kind of emotional affect (outside of that brief forceful standing of his ground on my lap). I spoke to him, touched his arms, handed him things as they were passed around by others, but he never did anything but look forward with a blank stare. He didn’t take things from me. He didn’t smile. The only emotion thus far was the few moments when he thought his spot on my lap would be threatened. When I was ready to resign myself to the assumption that maybe he had a learning disorder or some kind of brain damage, I noticed a tear running down his face. Though there was no change in his facial expression, he was crying. Tears ran down his cheeks for several minutes. I wiped away his tears with my finger. There still wasn’t any movement or change in expression. He didn’t offer any kind of emotion other than the tears. But after I wiped them away, he leaned back into my shoulder, snuggled into the fold of my arm, and fell into a deep sleep. I continued to hold him until we were ready to leave, at which point I laid him down on a padded bench and walked out of the building.

It was difficult to put him down. It was difficult to leave the orphanage. As short term missioners, we know we have to leave. But those who touch are lives, somehow change us … they become a part of us. I guess, in this way, we are living out one of the blessings of the Eucharist … where we are all one in Christ.

Click here for a description of our 2008 experience at El Hogar in Honduras. (PDF format)

As a sociologist, I’m always interested to know how people encounter the world. The following is a letter from a first-time missioner that I feel does a good job of capturing those many feelings and anxieties that we tend to feel when we first arrive in a new place. He has given me permission to share his encounter with Quito, Ecuador with you. I hope you enjoy sharing in his experience. Ted

We don’t often have much conversation around healthcare issues when we talk about global mission. I think we’re either uncomfortable, because we deem it something personal, or we’re afraid we’re scare people off. The reality, however, is that we all need to be equipped to exercise self-care.

First, let’s dispel the myth that somehow staying home will prevent exposure to things that might make us sick. To use an often overused phrase, we live in a global village. We come into contact with people who carry all kinds of things every day. In addition, you can die from contracting serious infections such as C-Diff in American hospitals, get food poisoning from manufactured products (… peanut butter crackers, anyone?), and get parasitic infections in restaurants from poor hygiene. Personally, I have had several major digestive illnesses/infections. While I may attribute some of them to my international travel, the fact remains that I could have contracted every single one without ever leaving the United States.

Mindful of the need for self-care, the questions I’d like to address include: 1 – What kinds of tips can help with pre-trip medical self-care? 2 – What kinds of things are worth considering while traveling? 3 – Tips on self-advocacy if life hands you a travel related digestive challenge?

Pre-trip Advice …

- Even before you head to any kind of medical clinic, educate yourself. Your first stop should be the travel pages of the CDC [ http://wwwn.cdc.gov/travel/default.aspx ]. It will provide you with specifics for your destination and prepare you to be an educated consumer.

- Go to a Travel Clinic, as opposed to your primary care physician (PCP). (Be aware, though, that coverage for travel medicine varies with HMOs. In some instances, you’ll have complete coverage and/or maybe a standard co-payment. In other instances you may pay up most or all of the cost yourself … which can run up to $600 or more.) Travel Clinics will have knowledgeable staff who are used to advising travelers. Your PCP may be well-intentioned, but may know little, if anything, more than you regarding your travel needs.

- When you go for your shots, take along an International Certification of Vaccinations, a little yellow booklet that fits inside your passport. Groups can purchase them in quantities … $45/100 available through Occupational & Travel Medical Supplies www.occmedsupplies.com (203-331-8649). This record provides a handy reference in the event of any kind of medical emergency. In addition, since countries are beginning to require certain vaccinations for entrance after traveling to certain locations, it’s useful to have a record with your passport.

- Take with you what you might need. If you tend toward sinus infections, take an antibiotic like clarithromycin (Biaxin) or Azithromycin (Z-pack). In the event of a major digestive issue, consider carrying ciprofloxacin (Cipro), another antibiotic often prescribed for things like urinary tract infections, digestive infections, etc. In ALL cases, don’t just ask for and take these medications. Be absolutely clear with your medical professional about your personal issues and how s/he recommends your use of these antibiotics. Before tossing back that first pill, keep in mind that you may be creating a new situation by taking the medications. Your digestive tract is filled with various bacteria, both good and bad. In a healthy system, the good bacteria (which some people boost with things like Acidophilus, the bacteria that makes yogurt) keeps the bad bacteria in check. When you take any type of antibiotic or steroid, YOU CHANGE THE BALANCE OF POWER. In other words, you may discover that taking the antibiotic has made you susceptible to a new infection. So don’t think of antibiotics as panaceas and be absolutely clear about what your taking and when … which is best determined between you and your medical provider.

- Be sure to have an adequate supply (extra) of any medication that you take regularly. Medications should always be packed in your carry-on. If your luggage goes to the Middle East when you’re en route to Africa, clothes are easily replaced … medications are not.

- Many of the medical aids you can, and should, consider packing are over the counter. TUMS and Pepto Bismol tablets are good for calming your stomach. When in the countryside, you might consider taking a tablet along with an acidophilus capsule before meals (in the privacy of your room, so you don’t offend anyone). Whether or not you take an anti-acid product, many travel doctors now recommend taking acidophilus supplements as a healthcare precaution.

Things to consider while traveling …

- CLOSED TOE SHOES ... mandatory ... many parasites access your system through your skin. Many also reside in soil. One way to fight them and possibly prevent exposure is to wear shoes whenever you're in the countryside. The best advice is to only wear open-toed shoes when you’re going to be primarily indoors.

- As stated above, only take antibiotics when/if absolutely necessary ... one of the ways that certain infections emerge is by having the good bacteria and enzymes in your system thrown off by antibiotics.

- There are a number of different opinions on this, but most professionals recommend taking a COMPLETE course of an antibiotic like Cipro when you start. My own feeling is that you shouldn’t stop when you start feeling better ... but rather, take a full course of a drug you were prescribed (usually 6 or 10 days). Again, though, you shouldn’t take my word on this … you should have a detailed conversation with a travel medical professional before deciding on proper doses of any medication.

Self-Advocacy (post-trip) ...

- If you start having odd bowel movements (diarrhea one day, constipation the next), pay attention to your body and speak with a medical professional. It’s a good idea to write up a couple of pages of your medical history along with your symptoms. Some practitioners will initially treat you like you’re a hypochondriac, but you’ll know they have the right information and you’ll also have an easily updated record for meeting with more than one healthcare provider.

- Be mindful of little changes such as not sleeping, or sleeping too much

- Eating issues that might seem like no big deal ... loss of appetite, feeling bloated, extra gassy, etc. ... could be signs. Pay attention and note what's not quite right, because the little things add up.

- ALWAYS start your conversation with “You need to know that I have been in _______.” This typically causes a doctor to start checking for parasitic infections (stool and blood samples) rather than assuming you have some other digestive disorder or illness. If you don’t say you’ve been traveling, they’ll assume things like colitis, diverticulitis, and gastritis. Unfortunately, they’ll find symptoms and inflammation that may lead them to believe they were correct, as you may have developed those related issues. What they won’t find is the culprit that caused you to have those symptoms in the first place. So you’ll receive temporary relief, think you’re well, and end up back at the doctors in a few months. In the meantime, you may take medication that inadvertently helps the parasite develop resistance.

- DON'T take “NO” or “YOU'LL BE FINE” for an answer. Be VERY persistent. No one knows your body better than you.

- EDUCATE yourself as much as possible starting with the CDC website. BUT, also be careful about where you gather information ... AVOID websites that are devoted to parasitic infections. Most are garbage, and are just glorified marketing campaigns to get you to buy their “miracle” anti-parasite treatment program.

- DON'T allow the medical establishment to rely on stool tests. Some people will tell you that is how parasites are found. THEY'RE WRONG! I’m aware of a hospital study (sorry, I don’t have a reference) in which they found that out of 2000 patients (using medical records as the reference), 50% had a parasitic infection. Only 2% of the participants had tested positive ... in other words, only 2% were identified through stool samples. That means that 980 people out of 2000 (a whopping 48%!!!), were initially told they didn't have a parasitic infection based on their stool samples. In addition, with HMO cut backs and cost savings, many labs run insufficient tests and/or have poorly trained lab techs leading to potentially incorrect findings.

- INSIST on blood tests. You want to know your white blood cell counts (particularly your eosinophils) and you want antibody and toxin tests for as many parasites as possible. Though some may find this a bit much, I like to find out the details of antibody tests and check with labs about how they run their tests. In the case of one particular parasite, I discovered that labs typically test for one toxin in the blood. Recent studies have shown, though, that the most reliable tests require two toxins. Before my physician ordered my blood work, I called all the regional labs to see how they conducted their lab tests. Based on that information, we selected the lab for my blood work.

- DON'T allow anyone to tell you, "Oh, it's common for people to have eosinophilia." If I had a buck for every doctor who said that, I might actually be able to start rebuilding my retirement account.

- Since many people can be asymptomatic, meaning you can be exposed to something but not have symptoms, you might want to consider adding some parasitic tests to your annual exam. For example, you may return from a trip and learn that one of the members in your group is ill with a particular parasite. Even if you don’t get sick, it’s worth determining whether or not you were exposed to the same thing. If you are having blood drawn anyway, you may ask for antibody tests for that particular parasitic infection. It’s a bit like stabbing in the dark, and most physicians will see it as an unnecessary expense, however, a positive result for a certain infection is a very good heads up for you and your doctor.

In closing, I want to make one last pitch about communication. We tend to treat healthcare as a very primate matter. That’s fine, and often very appropriate. However, when you’ve been on a mission trip with others, you are doing each other a disservice if you don’t communicate when a health issue arises. The catch is figuring out the best way to balance open communication with appropriate levels of privacy. If your issue is truly yours, you don’t want to panic everyone on your team that they have some rare disease, only to discover you have something like appendicitis that has nothing to do with your trip. On the other hand, if you are diagnosed with a parasitic infection that you are likely to have picked up on your travels, and to which others are likely to have been exposed, I would argue that you have a responsibility to the others in your group. You may be able to eliminate unnecessary worry, and provide substantive direction to their physician. The best way to manage how and when to communicate is probably to decide when you have sufficient information to make a judgment call. Just feeling sick may not be the time to publicize. But once you begin treatment in response to a positive test for a particular bacterial infection, you should probably contact your team leader and discuss the issue.

*Important Note: This document is not a complete medical guide for travelers. Always consult with medical professionals for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions.